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ORIGINAL RESEARCH ARTICLE

Incidence of mastoiditis in nasopharyngeal carcinoma following anti-PD-1 therapy: A propensity-matched analysis

Qi-Lun Guo1,2† ,  Yong-Long Liu1,2† ,  Wei-Jing Zhang2,3† ,  Kai Wen1,2 ,  Hui-Feng Li1,2 ,  Rui You1,2 ,  Si-Yuan Chen1,2 ,  Jian Li4 ,  Ming-Yuan Chen1,2 ,  Yi-Jun Hua1,2*
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1 Department of Nasopharyngeal Carcinoma, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
2 State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
3 Department of Medical Imaging, Sun Yat-sen University Cancer Center, Guangzhou, China
4 Institute of Molecular Medicine and Experimental Immunology, University Clinic of Rheinische Friedrich-Wilhelms-University, Bonn, Germany
CP, 4023
Submitted: 24 June 2024 | Accepted: 18 September 2024 | Published: 23 December 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Mastoiditis can be induced by radiotherapy and is closely associated with hearing loss. This study aimed to investigate the incidence of mastoiditis in patients with locally advanced nasopharyngeal carcinoma (LANPC) undergoing anti-programmed death 1 (PD-1) therapy. We retrospectively reviewed patients with primary locoregionally advanced nasopharyngeal carcinoma who received intensity-modulated radiotherapy and concurrent cisplatin-based chemotherapy with or without anti-PD-1 therapy from January 2020 to January 2022 in a single medical institution. Group A received neoadjuvant chemotherapy (NACT) + concurrent chemoradiotherapy (CCRT) + anti-PD-1 therapy, whereas Group B received the same treatment, except for anti-PD-1 therapy. We employed a propensity score matching method to match patients from each group in a 1:1 ratio. The severity of mastoiditis was assessed using magnetic resonance imaging, specifically grading mastoid opacification on a scale of 0 – 3. A total of 136 out of 259 eligible patients were propensity-matched, with 68 patients in Group A and 68 patients in Group B. No significant differences were observed in patient and tumor characteristics between the two groups. There were no significant differences in the incidence rates of severe mastoiditis between the two groups before NACT, before CCRT, at 0 months, and at 3 months following CCRT. However, the incidence rate of severe mastoiditis at 6 months following CCRT was significantly higher in Group A compared to Group B (35.3% vs. 20.6%, P = 0.008). Analysis of variance with repeated measures demonstrated that anti-PD-1 therapy did not increase the incidence rate of severe mastoiditis in LANPC patients compared to immunotherapy-free patients following CCRT (P = 0.24). LANPC patients receiving anti-PD-1 therapy did not significantly experience more severe mastoiditis during CCRT, but there was an increasing trend post-CCRT. Additional follow-up with a larger patient cohort is necessary to draw definitive conclusions.

Keywords
Nasopharyngeal carcinoma
Mastoiditis
Anti-PD-1 therapy
Propensity-score matching
Funding
This work was supported by the Enterprise Joint Fund of Guangdong Provincial Foundation for Basic and Applied Basic Research (2021A1515220021), The National Natural Science Foundation of China (Grant/Award Number: 81902638), Program of Sun Yat-Sen University for Clinical Research 5010 Program (No.2015011), and Wu Jieping Medical Foundation (Grant/Award Number: 320.6750.2021-01-38).
Conflict of interest
Yi-Jun Hua is an Editorial Board Member of this journal but was not in any way involved in the editorial and peer-review process conducted for this paper, directly or indirectly. Separately, other authors declared that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.
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Cancer Plus, Electronic ISSN: 2661-3840 Print ISSN: 2661-3832, Published by AccScience Publishing
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