石瑶,李斐然,朱奕,黄汇莹,龚洪立,曹鹏宇,徐成志,陶磊,周梁,张明

• 1:复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科
• 2:复旦大学附属眼耳鼻喉科医院放疗科

摘要(Abstract)：

目的:探讨新辅助免疫化疗对下咽鳞状细胞癌颈部转移淋巴结退缩的影响。方法:回顾性分析2017年7月至2025年3月在复旦大学附属眼耳鼻喉科医院头颈外科收治的存在颈部淋巴结转移的下咽鳞状细胞癌患者，根据初始治疗方案分为单纯诱导化疗组(101例)和新辅助免疫化疗组(126例),以客观缓解率(objective response rate, ORR)和影像学退缩率≥70%评估原发灶及颈部转移淋巴结的退缩情况。在原发灶影像学退缩率≥70%的患者中，分析颈部转移淋巴结退缩不足(影像学退缩率<70%)的影响因素。结果:新辅助免疫化疗组颈部转移淋巴结的ORR(71.4%)和影像学退缩率≥70%的比例(42.1%)均高于单纯诱导化疗组(ORR为47.5%;影像学退缩率≥70%的比例为10.9%;均P<0.001),但该组颈部退缩率仍低于其原发灶(ORR为88.1%,P=0.001;影像学退缩率≥70%的比例为70.6%,P<0.001)。在原发灶影像学退缩率≥70%的患者中，新辅助免疫化疗与颈部转移淋巴结退缩不足风险降低相关[OR(95%CI)为0.206(0.088,0.483),P<0.001],而N分期是颈部转移淋巴结退缩不足的危险因素[N2期：OR(95%CI)为2.673(1.111,6.431),P=0.028;N3期：OR(95%CI)为7.186(2.043,25.275),P=0.002]。结论:新辅助免疫化疗可提高下咽鳞状细胞癌患者颈部转移淋巴结的影像学退缩率，但仍不及原发灶。高N分期是影响颈部转移淋巴结退缩不足的独立危险因素。

关键词(KeyWords)： 下咽鳞状细胞癌;新辅助免疫化疗;颈部转移淋巴结;影像学退缩率

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(No:82273097);; 上海市自然科学基金(No:23ZR1409700)

作者(Author): 石瑶,李斐然,朱奕,黄汇莹,龚洪立,曹鹏宇,徐成志,陶磊,周梁,张明

DOI: 10.13201/j.issn.2096-7993.2026.10.009

参考文献(References)：

• [1] 中华耳鼻咽喉头颈外科杂志编辑委员会头颈外科组，中华医学会耳鼻咽喉头颈外科学分会头颈外科学组.下咽癌外科手术及综合治疗专家共识[J].中华耳鼻咽喉头颈外科杂志，2017,52(1):16-24.
• [2] Chung EJ,Kim GW,Cho BK,et al.Pattern of lymph node metastasis in hypopharyngeal squamous cell carcinoma and indications for level VI lymph node dissection[J].Head Neck,2016,Suppl 1:E1969-1973.
• [3] Ye LL,Rao J,Fan XW,et al.Impact of tumor dimensions and lymph node density on the survival of patients with hypopharyngeal squamous cell carcinoma[J].Cancer Manag Res,2018,10:4679-4688.
• [4] Wolf GT,Fisher SG.Effectiveness of salvage neck dissection for advanced regional metastases when induction chemotherapy and radiation are used for organ preservation[J].Laryngoscope,1992,102(8):934-939.
• [5] Da Mosto MC,Lupato V,Romeo S,et al.Is neck dissection necessary after induction plus concurrent chemoradiotherapy in complete responder head and neck cancer patients with pretherapy advanced nodal disease?[J].Ann Surg Oncol,2013,20(1):250-256.
• [6] Ferris RL,Blumenschein G Jr,Fayette J,et al.Nivolumab for recurrent squamous-cell carcinoma of the head and neck[J].N Engl J Med,2016,375(19):1856-1867.
• [7] Cohen EEW,Soulières D,Le Tourneau C,et al.Pembrolizumab versus methotrexate,docetaxel,or cetuximab for recurrent or metastatic head-and-neck squamous cell carcinoma(KEYNOTE-040):a randomised,open-label,phase 3 study[J].Lancet,2019,393(10167):156-167.
• [8] Burtness B,Harrington KJ,Greil R,et al.Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck(KEYNOTE-048):a randomised,open-label,phase 3 study[J].Lancet,2019,394(10212):1915-1928.
• [9] Uppaluri R,Haddad RI,Tao YG,et al.Neoadjuvant and adjuvant pembrolizumab in locally advanced head and neck cancer[J].N Engl J Med,2025,393(1):37-50.
• [10] Ou X,Zhai R,Wei W,et al.Induction Toripalimab and Chemotherapy for Organ Preservation in Locally Advanced Laryngeal and Hypopharyngeal Cancer:A Single-Arm Phase II Clinical Trial[J].Clin Cancer Res,2024,30(2):344-355.
• [11] Gong HL,Tian S,Ding H,et al.Camrelizumab-based induction chemoimmunotherapy in locally advanced stage hypopharyngeal carcinoma:phase II clinical trial[J].Nat Commun,2024,15(1):5251.
• [12] Gui L,Xie Z,Zhang W,et al.Tislelizumab plus nab-paclitaxel and cisplatin as induction immunochemotherapy for organ preservation of locally advanced hypopharyngeal squamous cell carcinoma:a single-arm phase II trial[J].ESMO Open,2025,10(8):105505.
• [13] Eisenhauer EA,Therasse P,Bogaerts J,et al.New response evaluation criteria in solid tumours:Revised RECIST guideline(version 1.1)[J].Eur J Cancer,2009,45(2):228-247.
• [14] Schwartz LH,Bogaerts J,Ford R,et al.Evaluation of lymph nodes with RECIST 1.1[J].Eur J Cancer,2009,45(2):261-267.
• [15] 田姝，龚洪立，侯娜娜，等.卡瑞利珠单抗联合化疗与单纯化疗在局部晚期下咽癌诱导治疗中的效果比较[J].中华医学杂志，2024,104(26):2401-2408.
• [16] Chen SS,Zhong Q,Zhang SR,et al.Neoadjuvant immunochemotherapy in locally advanced laryngeal cancer and hypopharyngeal cancer:higher objective response rate and organ-preservation rate[J].Investig New Drugs,2024,42(6):694-702.
• [17] Tang SP,Lin GB,Wu XB,et al.Efficacy of neoadjuvant pembrolizumab combined with paclitaxel and cisplatin in locally advanced oropharyngeal and hypopharyngeal squamous cell carcinoma:a retrospective study[J].Front Immunol,2025,16:1690935.
• [18] Zhai WY,Zhao ZR,Chen S,et al.Response of primary tumor and lymph node in non-small cell lung cancer after neoadjuvant immunotherapy:a pooled analysis[J].J Immunother Cancer,2022,10(9):e005160.
• [19] 陈新华，林和新，陈粤泓，等.术前使用免疫检查点抑制剂对胃癌转移淋巴结癌残留影响的回顾性研究[J].中华胃肠外科杂志，2024,27(7):694-701.
• [20] Merlino DJ,Johnson JM,Tuluc M,et al.Discordant responses between primary head and neck tumors and nodal metastases treated with neoadjuvant nivolumab:correlation of radiographic and pathologic treatment effect[J].Front Oncol,2020,10:566315.
• [21] Zhang W,Li JB,Liu HM,et al.PERK+ macrophages drive immunotherapy resistance in lymph node metastases of oral squamous cell carcinoma[J].Clin Cancer Res,2025,31(10):1894-1911.
• [22] 何扬，杨慧，孔维丽.蛋白质组与转录组分析联合预测头颈部鳞状细胞癌患者的生存率和免疫治疗反应[J].临床耳鼻咽喉头颈外科杂志，2025,39(11):1086-1093.
• [23] Lu DJ,Luu M,Gay C,et al.Nodal metastasis count and oncologic outcomes in head and neck cancer:a secondary analysis of NRG/RTOG 9501,NRG/RTOG 0234,and EORTC 22931[J].Int J Radiat Oncol Biol Phys,2022,113(4):787-795.
• [24] 徐丛，崔兰珍，刘晓晓，等.微血管密度、微淋巴管密度对下咽鳞状细胞癌患者预后的影响[J].临床耳鼻咽喉头颈外科杂志，2025,39(12):1143-1149.
• [25] Li FR,Hsueh C,Gong HL,et al.The management of metastatic neck nodes following induction chemotherapy in N2/3 classification hypopharyngeal carcinoma[J].Head Neck,2022,44(9):2009-2017.