Nasopharyngeal carcinoma (NPC) is highly radiosensitive, and radiotherapy is recommended for newly diagnosed NPC. Because of the poor visual surgical field, narrow operating space, difficulty protecting the internal carotid artery (ICA) and poor wound healing, the development of NPC surgery has been severely limited. For recurrent NPC, some open surgical approaches, such as the maxillary swing, successfully solve the above major problems. However, these operations are traumatic and lead to many postoperative complications. With the development of minimally invasive surgery, two concepts, the “third-hand technique” and “dumpling making technique”, have been proposed, combining with the intraoperative navigation systems and multiple anatomical landmarks for identifying ICA. Endoscopic nasopharyngectomy (ENPG) can also break through the above restrictions and has become a first-line treatment for locally recurrent NPC. Moreover, a new surgical staging system for recurrent NPC was devised to aid clinicians in choosing the most suitable treatment for these patients. A current study on ENPG alone for newly diagnosed stage I NPC shows that the long-term survival outcomes after ENPG are similar to those after IMRT. ENPG was associated with low medical costs and satisfactory QOL and might be an alternative strategy for treating newly diagnosed localized stage I NPC patients who refuse radiotherapy.
Treatment options for patients with recurrent/metastatic nasopharyngeal carcinoma (RM-NPC) are not clear after progression on previous treatment with PD-(L)1 inhibitor; critical gaps in evidence remain for such cases. Immunotherapy combined with antiangiogenic therapy has been reported to have synergistic antitumor activity. Therefore, we evaluated the efficacy and safety of camrelizumab plus famitinib in patients with RM-NPC who failed treatment with PD-1 inhibitor-containing regimens. This multicenter, adaptive Simon minimax two-stage, phase II study enrolled patients with RM-NPC refractory to at least one line of systemic platinum-containing chemotherapy and anti-PD-(L)1 immunotherapy. The patient received camrelizumab 200 mg every 3 weeks and famitinib 20 mg once per day. The primary endpoint was objective response rate (ORR), and the study could be stopped early as criterion for efficacy was met (>5 responses). Key secondary endpoints included time to response (TTR), disease control rate (DCR), progression-free survival (PFS), duration of response (DoR), overall survival (OS), and safety. This trial was registered with ClinicalTrials.gov, NCT04346381. Between October 12, 2020, and December 6, 2021, a total of 18 patients were enrolled since six responses were observed. The ORR was 33.3% (90% CI, 15.6-55.4) and the DCR was 77.8% (90% CI, 56.1-92.0). The median TTR was 2.1 months, the median DoR was 4.2 months (90% CI, 3.0-not reach), and the median PFS was 7.2 months (90% CI, 4.4-13.3), with a median follow-up duration of 16.7 months. Treatment-related adverse events (TRAEs) of grade ≥3 were reported in eight (44.4%) patients, with the most common being decreased platelet count and/or neutropenia (n = 4, 22.2%). Treatment-related serious AEs occurred in six (33.3%) patients, and no deaths occurred due to TRAEs. Four patients developed grade ≥3 nasopharyngeal necrosis; two of them developed grade 3-4 major epistaxis, and they were cured by nasal packing and vascular embolization. Camrelizumab plus famitinib exhibited encouraging efficacy and tolerable safety profiles in patients with RM-NPC who failed frontline immunotherapy. Further studies are needed to confirm and expand these findings. Jiangsu Hengrui Pharmaceutical Co., Ltd.
The aim of this study was to evaluate whether the platelet-to-lymphocyte ratio (PLR) could be used to predict the prognosis of patients with nasopharyngeal carcinoma (NPC). Patients (n = 1261) who were diagnosed with nonmetastatic NPC between January 2008 and December 2010 were recruited. The peripheral platelet and lymphocyte counts were retrieved, and the PLR was calculated. Univariate and multivariate Cox proportional hazards analyses were used to assess their association with PLR: overall survival (OS), cancer-specific survival (CSS), and distant metastasis-free survival (DMFS). The elevated PLR, using the third quartile values (153.64) as the optimal cutoff values, was found to be associated with the significant decline in CSS (hazard ratio [HR] 1.83, 95 % confidence interval [CI] 1.27–2.63, P < 0.001), OS (HR 1.81, 95 % CI 1.28–2.56, P < 0.001), and DMFS (HR 1.60, 95 % CI 1.15–2.23, P = 0.005) that remained significant during the multivariable analyses (CCS HR 1.84, 95 % CI 1.26–2.67, P < 0.001; OS HR 1.83, 95 % CI 1.28–2.61, P < 0.001; DMFS HR 1.56, 95 % CI 1.11–2.19, P = 0.011). Subgroup analyses indicated that the PLR could be used to stratify prognosis effectively for patients with early- or advanced-stage NPC, and Epstein–Barr virus DNA levels of ≥1500 copies/mL. In conclusions, elevated PLR values were associated with poor CSS, OS, and DMFS for patients with NPC; this easily accessed variable based on a large amount of cases multivariate analysis is valuable for predicting prognosis in patients with NPC.
Extramedullary plasmacytoma (EMP) is a rare malignant disease that lacks a unique clinical staging system to predict the survival of EMP patients and to design individualized treatment. Instead, clinicians have chosen to use the multiple myeloma (MM) staging system. Forty-eight EMP patients treated between 1996 and 2014 were included in this study. The new clinical stages were established according to independent survival factors using Cox regression model. Lymph node metastasis and a larger primary tumor (≥5 cm) were the only two independent poor prognostic factors for overall survival (OS) and disease-free survival (P < 0.05). Stage I was defined as the disease without those two poor prognostic factors. Stage II was defined as the presence of either factor, and Stage III was defined as the presence of both factors. OS was significantly different in each stage of the new staging system (P < 0.001), with a median follow-up time for Stage I, Stage II and Stage III of 68, 23 and 14 months. The new staging system had enhanced prognostic value compared to the MM staging system (the area under ROC 0.763 versus 0.520, P = 0.044). Although no difference was observed between treatments in Stage I, the combination treatment was associated with a significantly beneficial OS in the late stages (5-year OS: 15.3 % versus 79.5 %; P = 0.032). The new staging system exhibited a promising prognostic value for survival and could aid clinicians in choosing the most suitable treatment for EMP patients.
Introduction:Biopsy is essential for some patients with suspected distant metastasis, so we aim to figure out whether biopsy of distant metastasis is associated with impaired survival in NPC.Methods: A total of 743 synchronous metastatic NPC patients from 2004 to 2016 were analyzed from the population-based Surveillance, Epidemiology, and End Results program.Propensity score matching was used to control confounders and create a well-balanced cohort.Five-year survival rate estimates and Kaplan-Meier survival curves were calculated.Cox proportional hazard ratios (HRs) were used to identify independent prognostic factors for survival.Results: Of 743 eligible patients, 194 (26.11%) underwent biopsy of distant metastasis.After control for demographic and clinicopathologic characteristics, patients with biopsy of distant metastasis achieved comparable 5-year overall survival (OS) (20.3% vs 24.7%; P = 0.41) and 5-year cancer specific survival (CSS) (31.0%vs 33.6%; P = 0.35) with patients without biopsies.Multivariate analysis further confirmed that biopsy of distant metastasis was not associated with impaired OS (HR = 1.03, 95% CI = 0.84-1.25;P = 0.80) or CSS (HR = 1.07, 95% CI = 0.86-1.34;P = 0.54).Conclusions: Biopsy of distant metastasis was not associated with impaired survival outcomes for synchronous metastatic NPC patients.Biopsy of distant metastasis could be another diagnosed choice for patients with suspected distant metastasis.
Objective To assss the clinical significance of Cystatin C(Cys C)as a marker of renal function in kidney transplant patients especially when infection or acute rejection occured.Methods Among 65 renal transplant recipients the concentrations of serum Cys C and serum creatinine(Scr)were determined before and one month after the transplantation,and also in the day and next day of occurrence of infection or rejection.Meanwhile,30 healthy persons and 30 infected patients without kidney transplantations were served as control.Results The concentrations of Cys C were nearly equal between healthy persons and the infected patients without kidney transplantations(P = 0.32).The level of serum Cys C and Scr dropped quickly in the first 3 days after transplantation(decreased by 69.2%,74.7%,75.8% for Cys C and 38.4%,74.5%,81.4% for Scr)(P0.01).When infection occured,Cys C level increased(4.4± 1.5)days earlier than Scr did,and the level of serum Cys C and Scr increased by 39.4% and 35.3% respectively(P = 0.43).When acute rejection occured,Cys C level increased(2.7±1.8)days earlier than Scr did,and the level of serum Cys C and Scr increased by 148.9% and 43.9% respectively(P =0.0069). Compared with the level of stable state,Cys C increased by 38.7% and 108.5% during level of infection group and rejection group(P0.001),while Scr increased by 34.2% and 89.5% respectively(P 0.001).During the postoperative day 3 to day 28,there was a positive correlation between Cys C and Scr(r =0.785,P0.0001).ROC analysis showed the cut-off value of rejection group for Cys C and Scr were 1.79 mg/L and 122 μmol/L respectively.The sensitivity,specificity,positive predictive value,negative predictive value,coincidence rate and AUC in rejection group for Cys C were better than that for Scr(P 0.05).Conclusion Cys C is superior to Scr in reflecting the early changes of renal function,with high sensitivity and accuracy after the kidney transplantation.
Abstract Background Postradiation nasopharyngeal necrosis (PRNN) is a severe complication after radiotherapy in patients with nasopharyngeal carcinoma (NPC), which can severely affect the quality of life and threaten the patient's life. Only 13.4%–28.6% of patients can be cured by traditional repeated endoscopic debridement. Here, we introduced an innovative curative‐intent endoscopic surgery for PRNN patients and evaluated its clinical efficacy. Methods Clinical data of 72 PRNN patients who underwent radical endoscopic necrectomy, followed by reconstruction using a posterior pedicle nasal septum and floor mucoperiosteum flap were analyzed to determine the efficacy of this surgery. The endpoints were complete re‐epithelialization of the nasopharyngeal defect, relief of headache, and overall survival (OS). Results All surgeries were successfully performed without any severe postoperative complications or death. The median value of numeric rating scales of pain decreased from 8 before surgery to 0 after surgery ( P < 0.001). Fifty‐one patients (70.8%) achieved complete re‐epithelialization of the nasopharyngeal defect. The number of cycles of radiotherapy (odds ratio [OR], 7.254; 95% confidence interval [CI] 1.035–50.821; P = 0.046), postoperative pathological result (OR, 34.087; 95% CI 3.168–366.746; P = 0.004), and survival status of flap (OR, 261.179; 95% CI 17.176–3971.599; P < 0.001) were independent risk factors of re‐epithelialization of the nasopharyngeal defects. Postoperative pathological result (hazard ratio [HR], 5.018; 95% CI 1.970–12.782; P = 0.001) was an independent prognostic factor for OS. The 2‐year OS rate of the entire cohort was 77.9%. Conclusion Curative‐intent endoscopic necrectomy followed by construction using the posterior pedicle nasal septum and floor mucoperiosteum flap is a novel, safe, and effective treatment of PRNN in patients with NPC.
Objectives Nasopharyngeal carcinoma (NPC) patients with retropharyngeal lymph node (RPLN) recurrence typically undergo reirradiation and experience severe radiotoxicity. Salvage open surgery is challenging because gaining access to the retropharyngeal space is complex and risky. Thus, only several centers can perform this procedure, and complications are common. We applied transoral robotic surgery RPLN dissection (TORS‐RPLND) to NPC patients with RPLN recurrence to address the problem with open surgery. Materials and Methods From March 2017 to October 2020, 10 NPC patients with RPLN recurrence underwent TORS‐RPLND using the da Vinci Si/Xi Surgical System. We applied the balloon occlusion test to protect the internal carotid artery, induction chemotherapy to shrink large tumors preoperatively, and ultrasound positioning to effectively locate unrecognizable RPLNs during surgery. Clinical characteristics, complications, and survival outcome data were retrospectively collected. Results Of 10 patients, 8 underwent en bloc resection via TORS‐RPLND, and the remaining 2 patients were converted to open surgery because we failed to identify the RPLN during TORS. After introducing intraoperative ultrasound positioning, no such failure occurred. The mean operative time and intraoperative blood loss were 297 ± 120 min and 40 ± 43 ml, respectively. All surgical margins were negative. TORS‐related complications were mild, and the most severe one was grade 3 dysphagia in one patient who underwent conversion to open surgery (10%). With a median follow‐up of 19 months, only 1 (10%) patient developed cervical recurrence. Conclusions TORS‐RPLND is feasible, safe, and effective in the treatment of NPC patients with RPLN recurrence, especially with the help of intraoperative ultrasound positioning. Level of Evidence 4 Laryngoscope , 131:E1895–E1902, 2021
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