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Clinical characteristics and prognosis of immunotherapy for recurrent/metastatic nasopharyngeal carcinoma: a single-center retrospective analysis
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Abstract:
[Abstract] Objective: To investigate the clinical characteristics and prognostic factors of patients with recurrent or metastatic nasopharyngeal carcinoma (NPC) who received PD-1 inhibitor-based immunotherapy. Methods: A retrospective analysis was conducted on 95 patients with NPC diagnosed at General Hospital of the Southern Theater Command between March 2019 and July 2024. Clinical data, peripheral blood biochemical parameters, and immunological indicators were collected. Kaplan-Meier survival curves were used for prognostic comparisons. Log-rank test was used for comparison among groups. Univariate and multivariate analyses were performed using the Cox proportional hazards model. Results: Among the 95 patients, 81 were male and 14 were female, with a median age of 49.72 years (16-74 years). A total of 91 patients (95.79%) had stage Ⅳ disease. All patients received immunotherapy with or without chemotherapy. The median progression-free survival (mPFS) was 10.5 months, with an objective response rate (ORR) of 70.53% and a disease control rate (DCR) of 89.47%. Patients receiving platinum-based regimens had significantly longer PFS than those receiving non-platinum regimens. The paclitaxel + cisplatin + fluorouracil (TPF) regimen showed a longer PFS compared with the gemcitabine + cisplatin (GP) and paclitaxel + cisplatin (TP) regimen, although the differences were not statistically significant. No significant PFS differences were observed among different PD-1 inhibitor subgroups. Univariate and multivariate Cox analyses identified tumor recurrence status, baseline plasma EBV DNA status, number of treatment cycles, and baseline peripheral blood immune-inflammation index SII as independent efficacy predictors of PD-1 inhibitor-based therapy for patients with recurrent or metastatic NPC (all P < 0.05). Non-recurrent disease, baseline plasma EBV DNA positivity, 4 or more treatment cycles, and baseline peripheral blood SII < 772.81 were associated with better outcomes. Conclusion: In recurrent or metastatic NPC patients treated with PD-1 inhibitors, non-recurrent disease, baseline EBV DNA positivity, 4 or more treatment cycles, and peripheral blood SII < 772.81 were associated with prolonged PFS. These factors may help early identification of patients with suboptimal immunotherapy responses and enable timely individualized intervention.
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