动态治疗反应与癌症结果密切相关。本研究旨在评估纵向 Epstein-Barr 病毒 (EBV) DNA 和放射学肿瘤消退在局部晚期鼻咽癌 (LA-NPC) 风险分层和反应适应性治疗中的意义。来自两个中心的 1312 名患者总共被分配到训练组和验证组。基于EBV-DNA和肿瘤反应的多点检查，建立了4个诱导后化疗、4个放疗中期和4个放疗后亚组。然后根据不同的排列组合进一步产生七种表型。这些表型随后聚集成四个反应簇，反映了不同的生物治疗反应。四个反应簇与训练队列和外部验证队列中明显的 5 年无进展生存率相关（5 年：训练队列 91.1%、82.8%、30.6% 和 10.0%；外部验证 94.4%、55.6% 、 40.0% 和 12.7% ）与 TNM 分期和列线图模型相比具有优越的预后性能（一致性指数：训练队列 - 0.825 vs. 0.603 vs. 0.756，外部验证 - 0.834 vs. 0.606 vs. 0.789）。重要的是，反应集群在选择可以从辅助化疗中受益的候选人方面表现出了出色的能力。总之，基于放射学和生物反应动态评估的风险分层可以显着增强预后洞察力，并揭示 LA-NPC 的个体化治疗修改。版权所有 © 2024 Elsevier B.V. 保留所有权利。

Dynamic therapy response is strongly associated with cancer outcomes. This study aimed to evaluate the significance of longitudinal Epstein-Barr virus (EBV) DNA and radiological tumor regression in risk stratification and response-adaptive treatment in locally-advanced nasopharyngeal carcinoma (LA-NPC). In total, 1312 patients from two centers were assigned to the training and validation cohorts. Based on the multipoint examination of EBV-DNA and tumor response, four post-induction chemotherapy, four mid-radiotherapy, and four post-radiotherapy subgroups were established. Then seven phenotypes were further generated according to different permutations and combinations. These phenotypes were subsequently congregated into four response clusters, which reflect distinct biological treatment responses. The four response clusters correlated with an evident 5-year progression-free survival in both the training and external validation cohorts (5-year: training cohort 91.1 %, 82.8 %, 30.6 %, and 10.0 %; external validation 94.4 %, 55.6 %, 40.0 %, and 12.7 %) had superior prognostic performance compared to TNM staging and nomogram model (concordance index: training cohort-0.825 vs. 0.603 vs. 0.756 and external validation-0.834 vs. 0.606 vs. 0.789). Importantly, the response clusters exhibited an excellent capability in selecting candidates who can benefit from adjuvant chemotherapy. In conclusion, risk stratification based on the dynamic assessment of both radiological and biological responses can significantly enhance prognostic insights and shed light on individualized treatment modifications in LA-NPCs.Copyright © 2024 Elsevier B.V. All rights reserved.