Estimating Individualized Survival Benefit of Consolidative Metastasis-Directed Radiotherapy Following Chemoimmunotherapy in Nasopharyngeal Carcinoma With Exclusive Distant Metastasis.
4 affiliations
- 1Department of Head and Neck Surgery Sun Yat-sen University Cancer Center Guangzhou China.
- 2State Key Laboratory of Oncology in South China Guangzhou China.
- 3Guangdong Provincial Clinical Research Center for Cancer Guangzhou China.
- 4Department of Neurosurgery National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Abstract
Optimal patient selection for consolidative metastasis-directed radiotherapy (MDRT) after chemoimmunotherapy (CIT) remains uncertain in nasopharyngeal carcinoma (NPC) with exclusive distant metastasis, defined as distant metastasis without synchronous locoregional recurrence. This study was aimed at estimating the survival benefit of MDRT and identifying patients most likely to benefit. A total of 1083 patients from two independent centers were analyzed using a target trial emulation with cloning, artificial censoring, and inverse probability of censoring weighting. The emulation estimated a 4.2-month gain in 3-year progression-free survival (PFS) restricted mean survival time with the MDRT strategy (95% CI: 2.4-5.9; bootstrap p < 0.001). Eight survival machine-learning algorithms were developed and compared, among which the gradient boosting machine achieved 3-year PFS AUROCs of 0.875 in internal validation and 0.877 in geographical external validation. Heterogeneous treatment effects were further estimated using a T-learner framework across risk groups defined by recursive partitioning analysis. In the external cohort, model-estimated 3-year absolute risk reductions with MDRT were 21.6%, 14.7%, and 5.7% in intermediate-, low-, and high-risk groups, respectively. The framework was subsequently implemented as a web-based clinical decision-support system. These findings support individualized selection of consolidative MDRT after CIT and provide a practical framework for multidisciplinary decision-making.
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BibTeX
@article{wang2026estimating,
title = {{Estimating Individualized Survival Benefit of Consolidative Metastasis-Directed Radiotherapy Following Chemoimmunotherapy in Nasopharyngeal Carcinoma With Exclusive Distant Metastasis.}},
author = {Xuguang Wang and Shuwei Chen and Xing Zhang and Linfei Mao and Jingtao Chen and Shida Yan and Jiawei Xie and Xianlu Gao and Liji Zheng and Yujie Zeng and Shiting Zhang and Zekun Deng and Mingyuan Du and Ming Song},
journal = {MedComm},
year = {2026},
month = oct,
doi = {10.1002/mco2.71089},
url = {https://europepmc.org/article/MED/42921250},
note = {CC BY},
}
RIS
TY - JOUR
TI - Estimating Individualized Survival Benefit of Consolidative Metastasis-Directed Radiotherapy Following Chemoimmunotherapy in Nasopharyngeal Carcinoma With Exclusive Distant Metastasis.
AU - Xuguang Wang
AU - Shuwei Chen
AU - Xing Zhang
AU - Linfei Mao
AU - Jingtao Chen
AU - Shida Yan
AU - Jiawei Xie
AU - Xianlu Gao
AU - Liji Zheng
AU - Yujie Zeng
AU - Shiting Zhang
AU - Zekun Deng
AU - Mingyuan Du
AU - Ming Song
PY - 2026
DA - 2026/10/23
JO - MedComm
DO - 10.1002/mco2.71089
UR - https://europepmc.org/article/MED/42921250
AB - Optimal patient selection for consolidative metastasis-directed radiotherapy (MDRT) after chemoimmunotherapy (CIT) remains uncertain in nasopharyngeal carcinoma (NPC) with exclusive distant metastasis, defined as distant metastasis without synchronous locoregional recurrence. This study was aimed at estimating the survival benefit of MDRT and identifying patients most likely to benefit. A total of 1083 patients from two independent centers were analyzed using a target trial emulation with cloning, artificial censoring, and inverse probability of censoring weighting. The emulation estimated a 4.2-month gain in 3-year progression-free survival (PFS) restricted mean survival time with the MDRT strategy (95% CI: 2.4-5.9; bootstrap p < 0.001). Eight survival machine-learning algorithms were developed and compared, among which the gradient boosting machine achieved 3-year PFS AUROCs of 0.875 in internal validation and 0.877 in geographical external validation. Heterogeneous treatment effects were further estimated using a T-learner framework across risk groups defined by recursive partitioning analysis. In the external cohort, model-estimated 3-year absolute risk reductions with MDRT were 21.6%, 14.7%, and 5.7% in intermediate-, low-, and high-risk groups, respectively. The framework was subsequently implemented as a web-based clinical decision-support system. These findings support individualized selection of consolidative MDRT after CIT and provide a practical framework for multidisciplinary decision-making.
SN - 2688-2663
ER -