Factors determining the survival of nasopharyngeal carcinoma with lung metastasis alone: does combined modality treatment benefit?

Abstract

BackgroundNasopharyngeal carcinoma (NPC) with lung metastasis alone has been reported as a relatively favorable prognostic group, and combined modality treatment might be indicated for selected cases. However, the prognostic factors determining survival of this group and the indication of combined therapy have not been thoroughly studied.MethodsWe retrospectively reviewed 246 patients of NPC with lung metastasis(es) alone presented at diagnosis or as the first failure after primary treatment from 1993 to 2008 in an academic tertiary hospital. Univariate and multivariate survival analyses of post-metastasis survival (PMS) and overall survival (OS) were carried out to determine the prognostic factors.ResultsThe 3-year, 5-year, and 10-year of PMS and OS for the whole cohort were 34.3%, 17.0%, 8.6% and 67.8%, 45.4%, 18.5%, respectively. The median PMS (45.6 months vs. 23.7 months) and OS (73.7 months vs. 46.2 months) of patients treated with combined therapy was significantly longer than that of those treated with chemotherapy alone (P < 0.001). Age, disease-free interval (DFI) and treatment modality were evaluated as independent prognostic factors of OS, while only age and treatment modality retain their independent significance in PMS analysis. In stratified survival analysis, compared to chemotherapy alone, combined therapy could benefit the patients with DFI > 1 year, but not those with DFI ≤ 1 year.ConclusionsAge ≤ 45 years, DFI > 1 year, and the combined therapy were good prognostic factors for NPC patients with lung metastasis(es) alone. The combination of local therapy and the basic chemotherapy should be considered for these patients with DFI > 1 year.

Prognostic Factors on Overall Survival of Newly Diagnosed Metastatic Nasopharyngeal Carcinoma

“…Since 2011, concurrent chemo/radiotherapy has been another choice for selected patients (patients with distant metastasis in limited site or with small tumor burden, or patients with symptoms in the primary or any nodal site) in the guideline, emphasizing the importance of multidisciplinary therapy in newly diagnosed metastatic NPC. Concurred closely with other studies (Cao et al, 2011;Lin et al, 2012), we found a combination of radiotherapy for nasopharynx improved the OS. But the prognosis did not significantly relate to different radiation doses and techniques.…”

“…How many circles of chemotherapy are associated with better prognosis has been explored in some studies. Cao et al (2011) found no significant better overall survival in patients received more than 6 circles of chemotherapy. Lin et al (2012) chose 4 circles as the cut-off point, and the result was negative, too.…”

“…The median survival time ranges between 12.9-26.8 months (Toh et al, 2005;Cao et al, 2011;Lin et al, 2012). But a variable survival outcome is frequently observed in clinical practice.…”

“…Besides, the role of chemotherapy is well established for Jia-Xin Li 1, 2 , Shao-Min Huang 1 , Bi-Xiu Wen 2 , Tai-Xiang Lu 1 * metastatic NPC, but the objective response is still far from satisfied (Ngan et al, 2002;Chan et al, 2005;Leong et al, 2008). As NPC is highly sensitive to both chemotherapy and radiotherapy, whether local palliative radiotherapy for nasopharynx and metastatic tumors will provide additive value for overall survival when micro metastases are under control is a question worthy of consideration.…”

Ten years of experience in clinicopathologic characteristics, treatment and outcome of patients with nasopharyngeal pathologies in Yazd, Iran

“…The average survival for our patients was 94.5 ± 4.32 months (95% CI: 86.03–102.97 months). The median survival time of nasopharyngeal carcinoma varies between 12.9 and 26.8 months (17, 18). But a variable survival outcome is frequently discovered in clinical practice.…”