Influence of tumor necrosis on treatment sensitivity and long-term survival in nasopharyngeal carcinoma

• Published in: Radiotherapy and oncology Vol. 155; pp. 219 - 225
• Main Authors: Liang, Shao-Bo, Chen, Lu-Si, Yang, Xing-Li, Chen, Dan-Ming, Wang, Dong-Hui, Cui, Chun-Yan, Xie, Chuan-Bo, Liu, Li-Zhi, Xu, Xiang-Ying
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.02.2021
• Subjects: Carcinoma - pathology; Carcinoma - therapy; Disease-Free Survival; Gross tumor regression; Humans; Intensity-modulated radiotherapy; Nasopharyngeal carcinoma; Nasopharyngeal Carcinoma - therapy; Nasopharyngeal Neoplasms - pathology; Nasopharyngeal Neoplasms - radiotherapy; Necrosis; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Prognosis; Radiotherapy, Intensity-Modulated; Retrospective Studies; Survival; Tumor necrosis; Nasopharyngeal carcinoma; Gross tumor regression; Intensity-modulated radiotherapy; Tumor necrosis; Survival
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2020.11.011

•Tumor necrosis served as a predictor of treatment sensitivity and poor prognosis in patients with nasopharyngeal carcinoma (NPC).•Lymph node necrosis significantly improved the prognostic value of the current N classification criteria of NPC.•Patients with tumor necrosis might require effective strengthening treatment such as with radio chemotherapy sensitizers. To assess the impact of tumor necrosis on treatment sensitivity and long-term survival in patients with nasopharyngeal carcinoma (NPC) treated using intensity-modulated radiation therapy (IMRT). In total, 757 patients with non-metastatic, histologically confirmed NPC were retrospectively examined. All patients were treated using IMRT; 93.7% patients with stage T3-T4/N1-N3 disease also received cisplatin-based chemotherapy. The incidence rates of tumor necrosis in primary tumor, retropharyngeal lymph nodes, neck lymph nodes, and total tumor were 2%, 17.7%, 21.5%, and 31.4%. Overall, 40.8% patients with necrosis of the total tumor achieved complete response (CR) and 54.7% patients without tumor necrosis achieved CR at the end of treatment (χ2 = 12.728, P < 0.001). The estimated 7-year overall survival (OS), failure-free survival (FFS), distant metastasis-free survival (DMFS), and loco-regional relapse-free survival (LRRFS) for patients with tumor necrosis and without tumor necrosis of the total tumor were 68.5% vs. 88.4%, 70.5% vs. 88.1%, 77.6% vs. 90.6%, and 85.9% vs. 91.3%, respectively (all P < 0.001). Multivariate analyses indicated that necrosis of the total tumor was an independent predictor of OS, FFS, DMFS, and LRRFS. The impact of lymph node necrosis on long-term survival was similar to that of necrosis of the total tumor. ROC curves verified that inclusion of lymph node necrosis improved the predictive value of the current N classification criteria (P = 0.006). Tumor necrosis served as a predictor of treatment sensitivity and poor prognosis for patients with NPC. Lymph node necrosis significantly improved the prognostic value of the current N classification criteria for NPC.