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Sequential PD-1 inhibitor after adjuvant radiotherapy for postoperative oral cancer: a propensity score matching
Shaoqing Chen1,2, Ping Xie1, Runhong Mei2,3
1Department of Oncology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
Objective:
To explore the efficacy and safety of adjuvant radiotherapy and sequential programmed cell death protein-1 (PD-1) inhibitors in high-risk patients after oral cancer surgery.
Methods:
This single-center, retrospective study included high-risk oral cancer patients who received adjuvant therapy at The First Affiliated Hospital of Nanchang University from January 2013 to December 2024. Patients were divided into a PD-1 inhibitor group and a control group based on whether they received PD-1 inhibitor therapy. Propensity Score Matching (PSM) was used to match patients 1:1. Overall Survival (OS) and Adverse Events (AEs) were compared between the PD-1 inhibitor group and the control group.
Results:
A total of 262 patients were included in this study, comprising 125 in the PD-1 inhibitor group and 137 in the control group. After PSM, 89 patients from the PD-1 inhibitor group were successfully matched with 89 patients from the control group. The risk of death in the PD-1 inhibitor group was significantly lower than in the control group, with a Hazard Ratio (HR) of 0.54 (95% confidence interval [CI] 0.30-0.98), P = 0.04. The median OS was not reached (NR) in the PD-1 inhibitor group, whereas it was 55.0 months (95% CI, 48.2-63.5) in the control group. The incidence of adverse events in the PD-1 inhibitor group was higher than in the control group. The most common adverse reactions in the PD-1 inhibitor group were gastrointestinal reactions (40.0%), myelosuppression (31.2%), and oral mucositis (27.2%), all of which were higher than in the control group (4.4%, 5.1%, and 0%, respectively). Adverse events exclusive to the combination group included oral mucositis, radiation dermatitis (8.8%), and hepatitis. One death (0.7%) was reported in the monotherapy group, while there were no deaths in the combination group.
Conclusion:
In the adjuvant treatment of high-risk postoperative oral cancer patients, sequential PD-1 inhibitor can significantly improve patient survival benefits, but the incidence of adverse events is higher.