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Tumor Discovery Expert consensus of NUT carcinoma

3.3.2. Treatment sequence 3.5.1. Patient characteristics

(a) Treatment sequence 1 There were no statistically significant differences in
We analyzed the treatment sequences of various prognosis based on patient gender. Asian patients with
therapeutic approaches based on the timing when thoracic NUT carcinoma had better prognoses compared
patients initially received each treatment regimen. In to those from America (overall median survival [mOS]:
the literature dataset, approximately 51.92% (81/156) of 5 months) and Europe (mOS: 5 months), with an mOS
thoracic NUT carcinoma patients received chemotherapy of 11.4 months. No significant association between age
first, while 12.18% (19/156) underwent surgery. In head- and prognosis in NUT carcinoma was observed. TNM
and-neck NUT carcinoma patients, the majority initially stage, however, was statistically associated with prognosis:
underwent surgery (41.27%, 52/126), with some receiving patients in stages I–II had the best prognosis (mOS:
chemotherapy first (29.37%, 37/126). 54 months), followed by stage III (mOS: 14.9 months),
and stage IV had the poorest prognosis (mOS: 6 months).
(b) Treatment sequence 2 Among thoracic NUT carcinoma patients, a statistically
After initial treatment, many thoracic NUT carcinoma significant difference (P < 0.05) in prognosis was observed
patients continued to receive further treatment or, due to between stage III (mOS: 12.9 months) and stage IV (mOS:
the failure of previous treatments, underwent radiation 3 months).
therapy (14.1%, 22/156), chemotherapy (7.69%, 12/156),
or BET inhibitors (8.97%,14/156). In contrast, head-and- 3.5.2. Tumor characteristics
neck NUT carcinoma patients had a higher proportion As with other malignancies, tumor size can reflect
receiving subsequent radiation therapy (31.75%, 40/126), prognosis to some extent. NUT carcinoma tumors larger
followed by chemotherapy (23.02%, 29/126), and surgery than 7 cm had the worst prognosis (mOS: 5 months),
(9.52%, 12/126). followed by tumors between 5 cm and 7 cm (mOS:
(c) Treatment sequence 3 – 4 8 months). The best prognosis was observed in patients
The number of patients receiving third-line or later with tumors smaller than 5 cm (mOS: 12 months).
treatment was relatively small. Maintenance treatment However, in thoracic NUT carcinoma, different tumor
was primarily based on radiotherapy (7.96%, 27/339) and sizes showed statistically significant differences in
immunotherapy (2.95%, 10/339) among these patients. prognosis, with a dividing point at a diameter of 5 cm
Due to the generally poor prognosis of NUT carcinoma (mOS: 11.6 months). The prognosis of patients with
patients, the number of patients who received third-line thoracic NUT carcinoma and tumors between 5 – 7 cm
and subsequent treatments remained low. In our data, (mOS: 4 months) was not significantly different from
the proportion of patients receiving immunotherapy those with tumors larger than 7 cm (mOS: 4 months).
(1.47%) was slightly higher than those receiving other The prognosis for patients with BRD4::NUTM1 (mOS:
7 months) was significantly worse than that for patients
treatments.
with NSD3::NUTM1 (mOS: 21 months), with similar
3.4. Univariate and multivariate analyses findings observed in head and neck carcinoma patients.
Prognosis also varied with different metastatic sites.
Both multivariate and univariate analyses revealed that The prognosis for patients with bone metastasis (mOS:
the risk ratio for BRD3::NUTM1 and BRD4::NUTM1 6 months) and lung metastasis (mOS: 6 months) was
fusion partners was higher than that for other NUTM1 similar. There were no statistically significant differences
fusion partners, such as MAX gene-associated protein in survival analysis across different subgroups of the
(MGA). The risk ratio for NUT carcinoma originating in Ki-67 index (p=0.084). Minimal difference in prognosis
the thoracic region was higher than that for carcinoma was observed between the Ki-67 40–70% and >70%
originating in the head and neck. Patients with bone groups (mOS: 8 months [3.6, not available {NA}] versus 8
metastasis had a worse prognosis. Conversely, having months [5.7, NA]).
undergone radiotherapy, immunotherapy, or surgery was
identified as a protective factor for patient survival. In 3.5.3. Treatment strategy
addition, receiving radiation therapy as part of salvage We conducted survival analyses separately for patients who
treatment prolonged the survival of NUT carcinoma received surgery and immunotherapy, comparing them to
patients. Specific results are available in Figure S3. those who did not. The results demonstrated that patients
who underwent surgical treatment achieved a median
3.5. Survival analysis
survival time of 18.7 months (12.2-29), while patients
Further, details on survival data are provided in Table S6. without surgical intervention had a median survival time

Volume 3 Issue 4 (2024) 9 doi: 10.36922/td.4904