Computed tomography-derived body composition and early changes predict outcomes of first-line chemo-immunotherapy in recurrent/metastatic nasopharyngeal carcinoma

Abstract

Abstract Background Reliable biomarkers for risk stratification and treatment monitoring in recurrent/metastatic nasopharyngeal carcinoma (R/M NPC) treated with first-line chemo-immunotherapy remain limited. This study evaluated the prognostic value of baseline computed tomography (CT)-derived body composition parameters and their early dynamic changes. Methods In this single-center retrospective cohort study, patients with R/M NPC receiving first-line chemo-immunotherapy were included. The primary endpoint was progression-free survival (PFS), and secondary endpoints included overall survival (OS), objective response rate (ORR), and disease control rate (DCR). Associations between body composition and outcomes were analyzed. Results A total of 199 patients were included, and 99 with post-treatment CT after 2 cycles were further analyzed for dynamic changes. Higher baseline skeletal muscle area (SMA) was independently associated with longer PFS (HR = 0.56; 95% CI, 0.37-0.85; P = 0.006) and OS (HR = 0.46; 95% CI, 0.23-0.93; P = 0.03), and with higher ORR (82.8% vs 70.0%; P = 0.033) and DCR (98.0% vs 91.0%; P = .031). During early treatment, a ≤1.3% decrease or an increase in SMA was independently associated with longer PFS (HR = 0.53; P = 0.045) and OS (HR = 0.27; P = 0.018). A greater decline in visceral adipose tissue density (ΔVATD < −0.9%) was also associated with more favorable PFS and OS, whereas no significant difference in ORR was observed. Conclusion Baseline SMA and early changes in SMA and VATD have prognostic value in R/M NPC treated with first-line chemo-immunotherapy. CT-based body composition assessment may serve as a practical imaging biomarker for risk re-stratification and individualized management.