{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T14:11:51Z","timestamp":1788963111029,"version":"build-2803163510"},"reference-count":44,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100014418","name":"Harbin Medical University Cancer Hospital","doi-asserted-by":"publisher","award":["JJMS2022\u201002"],"award-info":[{"award-number":["JJMS2022\u201002"]}],"id":[{"id":"10.13039\/100014418","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82173341"],"award-info":[{"award-number":["82173341"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004735","name":"Natural Science Foundation of Hunan Province","doi-asserted-by":"publisher","award":["2023JJ20087"],"award-info":[{"award-number":["2023JJ20087"]}],"id":[{"id":"10.13039\/501100004735","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Immunology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    To evaluate the associations of body mass index (BMI) and metabolic syndrome (MetS) with outcomes in patients with recurrent or metastatic nasopharyngeal carcinoma (R\/M\u2010NPC) receiving anti\u2010PD\u20101 therapy, and to develop a prognostic model for overall survival (OS). This multicenter retrospective study included 238 patients with BMI\u2009\u2265\u200918.5\u2009kg\/m\n                    <jats:sup>2<\/jats:sup>\n                    from two Chinese hospitals. BMI and MetS associations were evaluated using center\u2010adjusted, center\u2010stratified, hierarchical, and quantitative sensitivity analyses. An OS nomogram was developed in the Xiangya cohort and externally evaluated in the Harbin cohort. In clinical confounder\u2010adjusted models with the exposures entered separately, high BMI was associated with OS (HR, 0.462; 95% CI, 0.324\u20130.657) and PFS (HR, 0.511; 95% CI, 0.380\u20130.688), and MetS was associated with OS (HR, 0.433; 95% CI, 0.278\u20130.674) and PFS (progression\u2010free survival) (HR, 0.616; 95% CI, 0.439\u20130.866). When BMI and MetS were jointly modelled, the MetS\u2010PFS association was attenuated (HR, 0.714; 95% CI, 0.504\u20131.012;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.058). Exploratory biomarker analyses revealed group differences in combined positive score (CPS) and pan\u2010immune\u2010inflammation value (PIV). Center\u2010specific effect directions were consistent, but the external\u2010center calibration slope was 0.53 (95% CI, 0.08\u20130.98). Among anti\u2010PD\u20101\u2010treated Chinese patients with R\/M\u2010NPC and a BMI\u2009\u2265\u200918.5\u2009kg\/m\n                    <jats:sup>2<\/jats:sup>\n                    , higher BMI and MetS showed prognostic associations. These observational data do not establish causal or treatment\u2010predictive effects, and prospective validation in non\u2010Chinese populations across the full body\u2010weight spectrum is needed.\n                  <\/jats:p>","DOI":"10.1111\/imm.70196","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:31:16Z","timestamp":1788960676000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Associations of\n                    <scp>BMI<\/scp>\n                    and Metabolic Syndrome With Outcomes After Anti\u2010\n                    <scp>PD<\/scp>\n                    \u20101 Therapy in Recurrent or Metastatic Nasopharyngeal Carcinoma"],"prefix":"10.1111","author":[{"given":"Haoyu","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Xiangya Hospital, Central South University  Changsha City China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9026-3384","authenticated-orcid":false,"given":"Jiaqi","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Xiangya Hospital, Central South University  Changsha City China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqiao","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Head and Neck Surgery Harbin Medical University Cancer Hospital  Harbin People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueying","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Xiangya Hospital, Central South University  Changsha City China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7347-3816","authenticated-orcid":false,"given":"Gangcai","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Xiangya Hospital, Central South University  Changsha City China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8366-5697","authenticated-orcid":false,"given":"Zhaoyu","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Head and Neck Surgery Hunan Children's Hospital  Changsha City China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunyun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Xiangya Hospital, Central South University  Changsha City China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6117-410X","authenticated-orcid":false,"given":"Kaibin","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Head and Neck Surgery Harbin Medical University Cancer Hospital  Harbin People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"issue":"10192","key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/S0140-6736(19)30956-0","article-title":"Nasopharyngeal Carcinoma","volume":"394","author":"Chen Y.","year":"2019","journal-title":"Lancet"},{"issue":"11","key":"e_1_2_14_3_1","doi-asserted-by":"crossref","first-page":"2515","DOI":"10.1007\/s11427-022-2240-6","article-title":"Overview and Countermeasures of Cancer Burden in China","volume":"66","author":"Wang Y.","year":"2023","journal-title":"Science China. Life Sciences"},{"issue":"2","key":"e_1_2_14_4_1","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1002\/mco2.32","article-title":"Advances in Pathogenesis and Precision Medicine for Nasopharyngeal Carcinoma","volume":"2","author":"Zhu Q. Y.","year":"2021","journal-title":"MedComm"},{"issue":"12","key":"e_1_2_14_5_1","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1038\/bjc.2017.357","article-title":"Systemic Therapies for Recurrent or Metastatic Nasopharyngeal Carcinoma: A Systematic Review","volume":"117","author":"Prawira A.","year":"2017","journal-title":"British Journal of Cancer"},{"key":"e_1_2_14_6_1","unstructured":"Network NCC \u201cNCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Head and Neck Cancers \u201d(2025)."},{"key":"e_1_2_14_7_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ctrv.2022.102428","article-title":"Clinical Trial Data of Anti\u2010PD\u20101\/PD\u2010L1 Therapy for Recurrent or Metastatic Nasopharyngeal Carcinoma: A Review","volume":"109","author":"Adkins D. R.","year":"2022","journal-title":"Cancer Treatment Reviews"},{"issue":"20","key":"e_1_2_14_8_1","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1001\/jama.2023.20181","article-title":"Toripalimab Plus Chemotherapy for Recurrent or Metastatic Nasopharyngeal Carcinoma","volume":"330","author":"Mai H.\u2010Q.","year":"2023","journal-title":"JAMA"},{"issue":"36","key":"e_1_2_14_9_1","doi-asserted-by":"crossref","first-page":"4050","DOI":"10.1200\/JCO.2017.73.3675","article-title":"Safety and Antitumor Activity of Pembrolizumab in Patients With Programmed Death\u2010Ligand 1\u2013Positive Nasopharyngeal Carcinoma: Results of the KEYNOTE\u2010028 Study","volume":"35","author":"Hsu C.","year":"2017","journal-title":"Journal of Clinical Oncology"},{"issue":"14","key":"e_1_2_14_10_1","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1200\/JCO.2017.77.0388","article-title":"Antitumor Activity of Nivolumab in Recurrent and Metastatic Nasopharyngeal Carcinoma: An International, Multicenter Study of the Mayo Clinic Phase 2 Consortium (NCI\u20109742)","volume":"36","author":"Ma B.","year":"2018","journal-title":"Journal of Clinical Oncology"},{"issue":"5","key":"e_1_2_14_11_1","doi-asserted-by":"crossref","first-page":"2967","DOI":"10.21873\/invivo.12127","article-title":"Investigation of the Efficacy and Safety of Nivolumab in Recurrent and Metastatic Nasopharyngeal Carcinoma","volume":"34","author":"Sato H.","year":"2020","journal-title":"In Vivo"},{"issue":"1","key":"e_1_2_14_12_1","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1038\/s41698-024-00601-1","article-title":"Immunotherapy for Recurrent or Metastatic Nasopharyngeal Carcinoma","volume":"8","author":"Liu X.","year":"2024","journal-title":"NPJ Precis Oncol"},{"key":"e_1_2_14_13_1","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.semcancer.2023.07.004","article-title":"Multifaceted Effects of Obesity on Cancer Immunotherapies: Bridging Preclinical Models and Clinical Data","volume":"95","author":"Vick L. V.","year":"2023","journal-title":"Seminars in Cancer Biology"},{"issue":"2","key":"e_1_2_14_14_1","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s13679-023-00497-1","article-title":"Obesity Paradox: Fact or Fiction?","volume":"12","author":"Simati S.","year":"2023","journal-title":"Current Obesity Reports"},{"key":"e_1_2_14_15_1","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.metabol.2018.11.001","article-title":"Obesity and Cancer Risk: Emerging Biological Mechanisms and Perspectives","volume":"92","author":"Avgerinos K. I.","year":"2019","journal-title":"Metabolism"},{"key":"e_1_2_14_16_1","article-title":"Analysis of Plasma Epstein\u2010Barr Virus DNA in Nasopharyngeal Cancer After Chemoradiation to Identify High\u2010Risk Patients for Adjuvant Chemotherapy: A Randomized Controlled Trial","volume":"36","author":"Chan A. T. C.","year":"2018","journal-title":"Journal of Clinical Oncology"},{"issue":"11","key":"e_1_2_14_17_1","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1002\/cac2.12100","article-title":"Clinical Utility of Epstein\u2010Barr Virus DNA and Other Liquid Biopsy Markers in Nasopharyngeal Carcinoma","volume":"40","author":"Tan R.","year":"2020","journal-title":"Cancer Commun (Lond)"},{"issue":"3","key":"e_1_2_14_18_1","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.0587","article-title":"Association of Plasma Epstein\u2010Barr Virus DNA With Outcomes for Patients With Recurrent or Metastatic Nasopharyngeal Carcinoma Receiving Anti\u2010Programmed Cell Death 1 Immunotherapy","volume":"5","author":"Xu J. Y.","year":"2022","journal-title":"JAMA Network Open"},{"issue":"5","key":"e_1_2_14_19_1","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1038\/s41591-018-0014-x","article-title":"Understanding the Tumor Immune Microenvironment (TIME) for Effective Therapy","volume":"24","author":"Binnewies M.","year":"2018","journal-title":"Nature Medicine"},{"key":"e_1_2_14_20_1","doi-asserted-by":"crossref","first-page":"4403","DOI":"10.1007\/s00330-025-11350-5","article-title":"Prediction of Immunotherapy Response in Nasopharyngeal Carcinoma: A Comparative Study Using MRI\u2010Based Radiomics Signature and Programmed Cell Death Ligand 1 Expression Score","volume":"35","author":"Mai H.","year":"2025","journal-title":"European Radiology"},{"key":"e_1_2_14_21_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.intimp.2023.110805","article-title":"Clinical Utility of Preoperative Pan\u2010Immune\u2010Inflammation Value (PIV) for Prognostication in Patients With Esophageal Squamous Cell Carcinoma","volume":"123","author":"Feng J.","year":"2023","journal-title":"International Immunopharmacology"},{"issue":"3","key":"e_1_2_14_22_1","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1038\/s41416-020-0894-7","article-title":"The Pan\u2010Immune\u2010Inflammation Value Is a New Prognostic Biomarker in Metastatic Colorectal Cancer: Results From a Pooled\u2010Analysis of the Valentino and TRIBE First\u2010Line Trials","volume":"123","author":"Fuca G.","year":"2020","journal-title":"British Journal of Cancer"},{"key":"e_1_2_14_23_1","doi-asserted-by":"crossref","first-page":"5413","DOI":"10.2147\/JIR.S385328","article-title":"Low Pre\u2010ChemoradiotherapyPan\u2010Immune\u2010Inflammation Value (PIV) Measures Predict Better Survival Outcomes in Locally Advanced Pancreatic Adenocarcinomas","volume":"15","author":"Topkan E.","year":"2022","journal-title":"Journal of Inflammation Research"},{"issue":"1","key":"e_1_2_14_24_1","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-021-94184-7","article-title":"Low Pan\u2010Immune\u2010Inflammation\u2010Value Predicts Better Chemotherapy Response and Survival in Breast Cancer Patients Treated With Neoadjuvant Chemotherapy","volume":"11","author":"Sahin A. B.","year":"2021","journal-title":"Scientific Reports"},{"issue":"7","key":"e_1_2_14_25_1","doi-asserted-by":"crossref","DOI":"10.1002\/cam4.7135","article-title":"Development and Internal Validation of a Nomogram Based on Peripheral Blood Inflammatory Markers for Predicting Prognosis in Nasopharyngeal Carcinoma","volume":"13","author":"Lai J.","year":"2024","journal-title":"Cancer Medicine"},{"issue":"2","key":"e_1_2_14_26_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2024.e24804","article-title":"Prognostic Significance of Pan\u2010Immune\u2010Inflammation Value (PIV) in Nasopharyngeal Carcinoma Patients","volume":"10","author":"Zhang N.","year":"2024","journal-title":"Heliyon"},{"issue":"5","key":"e_1_2_14_27_1","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/S1470-2045(10)70218-7","article-title":"Definition and Classification of Cancer Cachexia: An International Consensus","volume":"12","author":"Fearon K.","year":"2011","journal-title":"Lancet Oncology"},{"issue":"1","key":"e_1_2_14_28_1","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1200\/JCO.2014.56.1894","article-title":"Diagnostic Criteria for the Classification of Cancer\u2010Associated Weight Loss","volume":"33","author":"Martin L.","year":"2015","journal-title":"Journal of Clinical Oncology"},{"issue":"9491","key":"e_1_2_14_29_1","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1016\/S0140-6736(05)67402-8","article-title":"The Metabolic Syndrome\u2014A New Worldwide Definition","volume":"366","author":"Alberti K. 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L.","year":"2004","journal-title":"Clinical Cancer Research"},{"issue":"1","key":"e_1_2_14_32_1","doi-asserted-by":"crossref","DOI":"10.1136\/jitc-2024-009734","article-title":"Pan\u2010Tumor Analysis to Investigate the Obesity Paradox in Immune Checkpoint Blockade","volume":"13","author":"Alden S. L.","year":"2025","journal-title":"Journal for Immunotherapy of Cancer"},{"key":"e_1_2_14_33_1","doi-asserted-by":"crossref","first-page":"53","DOI":"10.3389\/fnut.2020.00053","article-title":"Obesity or BMI Paradox? Beneath the Tip of the Iceberg","volume":"7","author":"Donini L. M.","year":"2020","journal-title":"Frontiers in Nutrition"},{"issue":"3","key":"e_1_2_14_34_1","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1159\/000521241","article-title":"Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement","volume":"15","author":"Donini L. 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Q.","year":"2021","journal-title":"Nature Medicine"}],"container-title":["Immunology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imm.70196","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/imm.70196","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imm.70196","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:31:23Z","timestamp":1788960683000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imm.70196"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":44,"alternative-id":["10.1111\/imm.70196"],"URL":"https:\/\/doi.org\/10.1111\/imm.70196","archive":["Portico"],"relation":{},"ISSN":["0019-2805","1365-2567"],"issn-type":[{"value":"0019-2805","type":"print"},{"value":"1365-2567","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]},"assertion":[{"value":"2026-04-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"imm.70196"}}