Long Term Outcomes and Prognostic Factors of N₀Stage Nasopharyngeal Carcinoma: a Single Institutional Experience with 610 Patients

Abstract

Treatment responses of N 0 stage nasopharyngeal carcinoma were firstly analyzed comprehensively to evaluate long term outcomes of patients and identify prognostic factors. A total of 610 patients with N 0 NPC, undergoing definitive radiotherapy to their primary lesion and prophylactic radiation to upper neck, were reviewed retrospectively. Concomitant chemotherapy was administrated to 65 out of the 610. Survival rates of the patients were calculated using the Kaplan-Meier method and compared by log-rank test. Prognostic factors were identified by the Cox regression model. The study revealed the 5-year and 10-year overall, disease-free, disease-specific, local failure-free, regional failure-free, locoregional failure-free and distant metastasis-free survival rates to be 78.7% and 66.8%, 68.8% and 55.8%, 79.9% and 70.4%, 81.2% and 72.5%, 95.8% and 91.8%, 78.3% and 68.5%, 88.5% and 85.5%, respectively. There were 192 patients experiencing failure (31.5%) after radiotherapy or chemoradiotherapy. Of these, local recurrence, regional relapse and distant metastases as the first event of failure occurred in 100 (100/610, 16.4%), 15(15/610, 2.5%) and 52 (52/610, 8.5%), respectively. Multivariate analysis showed that T stage was the only independent prognostic factor for patients with N 0 NPC (P=0.000). Late T stage (P=0.000), male (P=0.039) and anemia (P=0.007) were independently unfavorable factors predicting disease-free survival. After treatment, satisfactory outcome wasgenerally achieved in patients with N 0 NPC. Local recurrence represented the predominant mode of treatment failure, while T stage was the only independent prognostic factor for overall survival. Late T stage, male gender, and anemia independently predicted lower possibility of the disease-free survival.

A randomized clinical trial comparing prophylactic upper versus whole‐neck irradiation in the treatment of patients with node‐negative nasopharyngeal carcinoma

“…Xie et al reported a 3‐year OS of 94.2% for patients treated with UNI and 91.9% for those treated with WNI. Results of 2 studies with longer follow‐up periods were also reported recently . The 5‐year OS rates were 78.7% and 89.8%, 5‐year RFS rates were 81.2% and 88.6%, and 5‐year MFS rates were 88.5% and 90.6%, for the studies by Chen et al and Sun et al, respectively, when the prophylactic irradiation volume included only the upper neck region.…”

“…Results of 2 studies with longer follow-up periods were also reported recently. 15,25 The 5-year OS rates were 78.7% and 89.8%, 5-year RFS rates were 81.2% and 88.6%, and 5-year MFS rates were 88.5% and 90.6%, for the studies by Chen et al 15 and Sun et al, 25 respectively, when the prophylactic irradiation volume included only the upper neck region. These results suggest that tumor control and survival are not adversely affected when the lower neck is omitted during WNI in the treatment of patients with N0 NPC.…”

Prognostic value of pretreatment serum levels of lactate dehydrogenase in nonmetastatic nasopharyngeal carcinoma: single-site analysis of 601 patients in a highly endemic area

“…Second, of the patients with late-stage NPC in our cohort, about 47% (159/339) had locally advanced staging (T3-4N0-1M0). Previous studies have suggested that chemotherapy could not significantly reduce the risk of death in patients with T3-4N0-1M0 NPC or the rate of local recurrence and distant metastasis in those with T3-4N0 M0 disease,51,52 suggesting that patients with T3-4N0-1M0 disease might also obtain less benefit from chemotherapy. Inclusion of patients with locally advanced-stage NPC might have reduced the beneficial effects of chemotherapy and thus weakened the effect of chemotherapy as a prognostic indicator for NPC in our study.…”

Reirradiation with Robotic Stereotactic Body Radiotherapy for Recurrent Nasopharyngeal Carcinoma

“…In our series the 41.7% of the cases were with rT3-4 and 29.2% were with rStage-4 disease. Recurrent tumor T stage has been presented as a prognostic factor in many previously reported series (Chua et al, 2005;Oksuz et al, 2009;Koutcher et al, 2010;Ozyigit et al, 2011;El-Sherbieny et al, 2011;Sun et al, 2012) . The poor outcome with advanced rT lesions may be related to poor target coverage due to nearby critical structures.…”