Prognostic Factors in Nasopharyngeal Cancer

Abstract Background and purpose Concurrent chemoradiotherapy is the established treatment for locally advanced nasopharyngeal carcinoma (NPC). However, there is no evidence supporting routine adjuvant chemotherapy. We aimed to demonstrate the effect of adjuvant chemotherapy on survival and distant metastasis in high-risk N3 NPC patients. Materials and methods We linked the Taiwan Cancer Registry and Cause of Death database to obtain data. Clinical N3 NPC patients were divided as those receiving definitive concurrent chemoradiotherapy (CCRT) with adjuvant 5-fluorouracil and platinum (PF) chemotherapy and those receiving no chemotherapy after CCRT. Patients receiving neoadjuvant chemotherapy were excluded. We compared overall survival, disease-free survival, local control, and distant metastasis in both groups using Cox proportional hazards regression analysis. Results We included 431 patients (152 and 279 patients in the adjuvant PF and observation groups, respectively). Median follow-up was 4.3 years. The 5-year overall survival were 69.1% and 57.4% in the adjuvant PF chemotherapy and observation groups, respectively (p = 0.02). Adjuvant PF chemotherapy was associated with a lower risk of death (hazard ratio [HR] = 0.61, 95% confidence interval [CI]: 0.43–0.84; p = 0.003), even after adjusting for baseline prognostic factors (HR = 0.61, 95% CI: 0.43–0.86; p = 0.005). Distant metastasis-free survival at 12 months was higher in the adjuvant PF chemotherapy group than in the observation group (98% vs 84.8%; p < 0.001). After adjusting for baseline prognostic factors, adjuvant PF chemotherapy was associated with freedom from distant metastasis (HR = 0.11, 95% CI: 0.02–0.46; p = 0.003). Conclusion Prospective evaluation of adjuvant PF chemotherapy in N3 NPC patients treated with definitive CCRT is warranted because adjuvant PF chemotherapy was associated with improved overall survival and decreased risk of distant metastasis.

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PO-0729 Prognostic factors analysis in a cohort of Nasopharyngeal cancer patients with 5-year follow-up

Radiotherapy and Oncology ◽

10.1016/s0167-8140(19)31149-1 ◽

2019 ◽

Vol 133 ◽

pp. S374

Author(s):

N.A. Iacovelli ◽

A. Cavallo ◽

A. Cicchetti ◽

L. Ferella ◽

N. Facchinetti ◽

...

Keyword(s):

Prognostic Factors ◽

Cancer Patients ◽

Nasopharyngeal Cancer ◽

Factors Analysis

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Clinical Characteristics and Prognostic Factors of Nasopharyngeal Cancer

Yeungnam University Journal of Medicine ◽

10.12701/yujm.2005.22.1.72 ◽

2005 ◽

Vol 22 (1) ◽

pp. 72

Author(s):

Chang Hoon Bai ◽

Young Jung Seo ◽

Sang Baik Ye ◽

Young Ho Choi ◽

Yong Dae Kim ◽

...

Keyword(s):

Prognostic Factors ◽

Clinical Characteristics ◽

Nasopharyngeal Cancer

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Prognostic Factors for Overall Survival in Nasopharyngeal Cancer and Implication for TNM Staging by UICC: A Systematic Review of the Literature

Frontiers in Oncology ◽

10.3389/fonc.2021.703995 ◽

2021 ◽

Vol 11 ◽

Author(s):

Chi Leung Chiang ◽

Qiaojuan Guo ◽

Wai Tong Ng ◽

Shaojun Lin ◽

Tiffany Sze Wai Ma ◽

...

Keyword(s):

Systematic Review ◽

Overall Survival ◽

Prognostic Factors ◽

Lymph Node ◽

Tnm Classification ◽

Nasopharyngeal Cancer ◽

Tnm Staging ◽

Review Of The Literature ◽

Level Of Evidence ◽

Neutrophil Lymphocyte Ratio

This study aims to identify prognostic factors in nasopharyngeal carcinoma (NPC) to improve the current 8th edition TNM classification. A systematic review of the literature reported between 2013 and 2019 in PubMed, Embase, and Scopus was conducted. Studies were included if (1) original clinical studies, (2) ≥50 NPC patients, and (3) analyses on the association between prognostic factors and overall survival. The data elements of eligible studies were abstracted and analyzed. A level of evidence was synthesized for each suggested change to the TNM staging and prognostic factors. Of 5,595 studies screened, 108 studies (44 studies on anatomical criteria and 64 on non-anatomical factors) were selected. Proposed changes/factors with strong evidence included the upstaging paranasal sinus to T4, defining parotid lymph node as N3, upstaging N-category based on presence of lymph node necrosis, as well as the incorporation of non-TNM factors including EBV-DNA level, primary gross tumor volume (GTV), nodal GTV, neutrophil-lymphocyte ratio, lactate dehydrogenase, C-reactive protein/albumin ratio, platelet count, SUVmax of the primary tumor, and total lesion glycolysis. This systematic review provides a useful summary of suggestions and prognostic factors that potentially improve the current staging system. Further validation studies are warranted to confirm their significance.

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Clinical Outcomes and Prognostic Factors of Locally Advanced Nasopharyngeal Cancer Treated with Intensity Modulated Radiotherapy: First Experience Report from Northeast India

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/s12070-021-02653-2 ◽

2021 ◽

Author(s):

Gautam Sarma ◽

Moumita Paul ◽

Jyotiman Nath ◽

Partha Pratim Medhi ◽

Mouchumee Bhattacharyya ◽

...

Keyword(s):

Prognostic Factors ◽

Clinical Outcomes ◽

Locally Advanced ◽

Nasopharyngeal Cancer ◽

Intensity Modulated Radiotherapy ◽

Northeast India ◽

Experience Report ◽

Intensity Modulated

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Survival outcome and prognostic factors of patients with nasopharyngeal cancer in Yogyakarta, Indonesia: A hospital-based retrospective study

PLoS ONE ◽

10.1371/journal.pone.0246638 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246638

Author(s):

Susanna Hilda Hutajulu ◽

Daniel Howdon ◽

Kartika Widayati Taroeno-Hariadi ◽

Mardiah Suci Hardianti ◽

Ibnu Purwanto ◽

...

Keyword(s):

Prognostic Factors ◽

Treatment Modality ◽

Proportional Hazards ◽

Nasopharyngeal Cancer ◽

Cox Proportional Hazards ◽

Survival Outcome ◽

Parametric Models ◽

P Values ◽

Education Status ◽

Multivariable Analyses

Purpose This study aimed to determine the survival outcome and prognostic factors of patients with nasopharyngeal cancer accessing treatment in Yogyakarta, Indonesia. Methods Data on 759 patients with NPC diagnosed from 2007 to 2016 at Dr Sardjito General Hospital were included. Potential prognostic variables included sociodemographic, clinicopathology and treatment parameters. Multivariable analyses were implemented using semi-parametric Cox proportional hazards modelling and fully parametric survival analysis. Results The median time of observation was 14.39 months. In the whole cohort the median observed survival was 31.08 months. In the univariable analysis, age, education status, insurance type, BMI, ECOG index, stage and treatment strategy had an impact on overall survival (OS) (p values <0.01). Semi-parametric multivariable analyses with stage stratification showed that education status, ECOG index, and treatment modality were independent prognostic factors for OS (p values <0.05). In the fully parametric models age, education status, ECOG index, stage, and treatment modality were independent prognostic factors for OS (p values <0.05). For both multivariable analyses, all treatment strategies were associated with a reduced hazard (semi-parametric models, p values <0.05) and a better OS (parametric models, p values <0.05) compared with no treatment. Furthermore, compared with radiation alone or chemotherapy alone, a combination of chemotherapy and radiation either in a form of concurrent chemoradiotherapy (CCRT), sequential chemotherapy and radiation, or induction chemotherapy followed by CCRT demonstrated a reduced hazard (hazard ratio/HR 0.226, 95% confidence interval/CI 0.089–0.363, and HR 0.390, 95%CI 0.260–0.519) and a better OS (time ratio/TR 3.108, 95%CI 1.274–4.942 and TR 2.531, 95%CI 1.829–3.233) (p values < 0.01). Conclusions Median OS for the cohort was low compared to those reported in both endemic and non-endemic regions. By combining the findings of multivariable analyses, we showed that age, education status, ECOG index, stage and first treatment modality were independent predictors for the OS.

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