Oncologic Outcomes in Nasopharyngeal Carcinoma: Influence of Treatment Modalities and Other Prognostic Factors

Introduction: Nasopharyngeal carcinoma (NPC) demonstrates distinct geographical distribution. However, radiation therapy represents the foundational treatment around the globe. Recently, induction chemotherapy plus chemoradiation (IC + CCRT) has been favored over chemoradiation plus adjuvant chemotherapy (CCRT + AC) due to its perceived better tolerance and earlier elimination of micro-metastases. This large retrospective study aimed to compare overall survival (OS) of different treatment regimens and identify prognostic factors.

Method: We conducted a retrospective analysis of 155 NPC patients treated at a single tertiary institution during 2000 to 2022. Demographic, clinical, and survival data were extracted from medical records.

Results: We included a total of 155 patients with an average age of 55 years of whom 73.5% are female. The cohort comprised 66, 21 and 13% of white, African American, and Asian, respectively. 36% of patients were current smokers, 30% were former smokers, and 34% were never smokers. One-third of patients were alcohol drinkers and 14% were marijuana users. Ninety patients were stained for P16 and 42% (38) were positive. EBV was tested in 126 patients finding that 54% (69) were positive. A total of 47 (30%), 46 (30%), and 57 (37%) patients received IC + CCRT, CCRT + AC, and only CCRT, respectively. Interestingly, EBV and p16 showed significant difference among races and WHO grades. Multivariate Cox analysis shows that smoking status and advanced tumor stage (IV) conferred substantially higher risk of recurrence. Female sex was a favorable prognostic factor for progression-free survival. Age, smoking status, and WHO grade were predictors for overall survival. Alcohol consumption was lower in survivors (mean: 2 vs. 5.5 standard cups; p = 0.035). Kaplan–Meier analysis identified female gender (p = 0.029), never smoking (p < 0.001), EBV positivity (p = 0.001), lower grade (p < 0.001), and earlier AJCC 8th stage (p < 0.001) as factors associated with superior OS. Also, increasing smoking index and age correlated with worse OS (hazard ratio: 1.01–1.02, p < 0.001; 1.02–1.06, p < 0.001, respectively). Race, alcohol, marijuana, p16 status, and treatment modalities (IC + CCRT vs. CCRT + AC vs. CCRT alone) did not impact OS.

Conclusion: We identified several clinical and tumor-related prognostic factors for OS in NPC patients, including gender, smoking, EBV status, grade, and stage. However, none of the studied treatment regimens confer any OS advantage. Our data suggests that quitting or reducing smoking and reducing alcohol consumption improve OS. In comparison to most recent studies, we did not find an impact of p16 on overall survival ([Tables 1] [2] [3]).

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
07 February 2025