[Prediction of pathological remission of head and neck squamous cell carcinoma patients after neoadjuvant immunochemotherapy and construction of clinical model based on clinical features and inflammatory markers].

Objective: To analyze the potential clinical biological factors influencing the major pathological response (MPR) to neoadjuvant immunochemotherapy in patients with resectable head and neck squamous cell carcinoma (HNSCC). Methods: This retrospective study enrolled patients with resectable HNSCC who underwent neoadjuvant immunochemotherapy at Sun Yat-sen University Cancer Center from June 1, 2019 to December 31, 2021. Binary logistic regression was used to analyze the correlation between clinical characteristics, inflammatory markers and MPR, and a nomogram model was constructed. The calibration curve and decision curve analysis were used to verify the predictive ability and accuracy of the nomogram model. Results: A total of 173 patients were included in the study, with 141 males and 32 females, aged from 22 to 83 years. After pathological assessment, the patients were divided into two groups: MPR group (108 cases) and non MPR group (65 cases). Logistics regression analysis indicated that the patients with HPV+oropharyngeal cancer, partial response or complete response by imaging assessment, low pre-treatment platelet/lymphocyte ratio, low pre-treatment C reactive protein/albumin ratio and lower pre-and post-treatment C reactive protein/albumin ratio difference were more likely to have MPR (all P<0.05). Nomogram model was constructed based on the above factors, with a C-index of 0.826 (95%CI: 0.760-0.892), and the calibration curve and decision curve analysis confirmed the prediction accuracy of the model. Conclusion: This study shows that many factors are related to MPR of patients with resectable HNSCC receiving neoadjuvant immunochemotherapy and the constructed nomogram model helps to develop personalized treatment strategies for the patients.目的： 分析新辅助免疫化疗的患者发生主要病理缓解（major pathological response，MPR）的临床生物学影响因素。 方法： 回顾性收集2019年6月1日至2021年12月31日在中山大学肿瘤防治中心进行新辅助免疫化疗的可手术的初治头颈部鳞状细胞癌（head and neck squamous cell carcinoma，HNSCC）病例。通过二元Logistic回归分析患者的临床特征及炎症标志物与MPR的相关性，构建列线图模型并利用校正曲线和决策曲线分析验证列线图的预测能力和准确性。 结果： 共纳入173例患者，男性141例，女性32例，年龄22~83岁。通过病理评估，将患者分为MPR（108例）和非MPR（65例）2组。通过Logistic回归分析得出，HPV+口咽癌、影像学评估部分缓解或完全缓解、较低的治疗前血小板-淋巴细胞比值（platelet to lymphocyte ratio，PLR）、较低的治疗前C反应蛋白/白蛋白比值（C reactive protein/albumin ratio，CAR）以及较低的治疗前后CAR差值的患者更易出现MPR（P值均<0.05）。根据上述因素构建了列线图模型，其中，C指数为0.826（95%CI：0.760~0.892），以校正曲线和决策曲线分析均证实了该模型的预测准确性。 结论： 本研究分析接受新辅助免疫化疗的可切除的HNSCC患者发生MPR的相关因素，并成功构建了预测MPR的列线图模型。.