Cervical nodal necrosis is an independent survival predictor in nasopharyngeal carcinoma: an observational cohort study

• Published in: OncoTargets and therapy Vol. 9; pp. 6775 - 6783
• Main Authors: Luo, Yangkun, Ren, Jing, Zhou, Peng, Gao, Yang, Yang, Guangquan, Lang, Jinyi
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2016; Taylor & Francis Ltd; Dove Medical Press
• Subjects: Cancer; Cancer therapies; Carcinoma; Care and treatment; Chemotherapy; Cohort analysis; Development and progression; Diagnosis; Family medical history; Lymphatic system; Medical imaging; Medical prognosis; Metastasis; Nasopharyngeal cancer; Necrosis; NMR; Nuclear magnetic resonance; Observational studies; Oncology; Oncology, Experimental; Original Research; Patients; Prognosis; Radiation therapy; Radiotherapy; Sinuses; Throat cancer; China; United States > US; cervical nodal necrosis; intensity-modulated radiotherapy; nasopharyngeal carcinoma; prognostic factor; chemotherapy
• ISSN: 1178-6930; 1178-6930
• DOI: 10.2147/OTT.S110558

Most nasopharyngeal carcinoma (NPC) patients present with locoregionally advanced disease at the time of diagnosis; however, there is a lack of consensus on specific prognostic factors potentially improving overall survival, especially in late-stage disease. Herein, we conducted a retrospective study to evaluate various potential prognostic factors in order to provide useful information for clinical treatment of T3/T4-stage NPC. A total of 189 previously untreated NPC patients were enrolled in the current study. All patients received intensity-modulated radiotherapy. Survival, death, relapse-free survival (both local and regional), and metastasis were recorded during follow-up. Factors affecting patient survival were assessed by using univariate and multivariate analyses. The median follow-up time was 69 months. The 5-year local-regional recurrence-free survival, distant metastasis-free survival, progression-free survival (PFS), and overall survival (OS) of the entire group were 89.8%, 71.5%, 66.3%, and 68.9%, respectively. Univariate analysis revealed significant differences in the 5-year PFS (58.5% vs 72.5%, =0.015) and OS (59.5% vs 75.8%, =0.033) rates of patients with and without cervical nodal necrosis (CNN). Subgroup analyses revealed that CNN was associated with poorer distant metastasis-free survival and PFS among patients with N2 stage ( =0.046 and =0.005) and with poorer PFS among patients with T3 or III stage (all =0.022). Multivariate analysis revealed CNN to be an independent prognostic factor for PFS and OS (PFS: adjusted hazard ratio, 1.860; 95% CI: 1.134-3.051; =0.014; OS: adjusted hazard ratio, 1.754; 95% CI: 1.061-2.899; =0.028). CNN is a potential independent negative prognostic factor in NPC patients. Our results suggest that stratification of NPC patients based on their CNN status should be considered as part of NPC disease management.