A Comprehensive Analysis of Treatment Management and Survival Outcomes in Nasopharyngeal Carcinoma. (24th November 2020)

• Record Type: Journal Article
• Authors: Goshtasbi, Khodayar; Lehrich, Brandon M.; Birkenbeuel, Jack L.; Abiri, Arash; Harris, Jeremy P.; Kuan, Edward C.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 165:Number 1(2021)
• Page Start: 93
• Page End: 103
• Publication Date: 2020-11-24
• Subjects: nasopharyngeal carcinoma -- NPC -- chemoradiotherapy -- radiation oncology -- overall survival -- NCDB; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599820973241
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : Objectives: To comprehensively investigate nasopharyngeal carcinoma (NPC) treatment, overall survival (OS), and the influence of clinical/sociodemographic factors on outcome. Study Design: Retrospective database study. Setting: National Cancer Database. Methods: The 2004‐2015 National Cancer Database was queried for all patients with NPC receiving definitive treatment. Log‐rank tests and Cox proportional hazards models were used for statistical analyses. Results: A total of 8260 patients with NPC were included (71.4% male; 42.5% with keratinizing histology; mean ± SD age, 52.1 ± 15.1 years), with a 5‐year OS of 63.4%. Multivariate predictors of mortality included age ≥65 years (hazard ratio [HR], 1.81; P <. 001), Charlson/Deyo score ≥1 (HR, 1.27; P =. 001), American Joint Committee on Cancer clinical stage III to IV (HR, 1.85; P <. 001), and government insurance or no insurance (HR, 1.53; P <. 001). Predictors of survival included female sex (HR, 0.82; P =. 002), Asian/Pacific Islander race (HR, 0.74; P <. 001), nonkeratinizing/undifferentiated histology (HR, 0.79; P =. 004), and receiving treatment at academic centers (HR, 0.87; P =. 02). Chemoradiotherapy (CRT) demonstrated improved OS as compared with radiotherapy (RT) only for stage II ( P =. 006) and stage III ( P =. 005) and with RT or chemotherapy only in stage IVA NPC ( P <. 001). When compared with CRT alone, surgery plus CRT provided OS benefits in keratinizing ( P =. 013) or stage IVA ( P =. 030) NPC. When compared with RT, CRT provided OS benefits in keratinizing ( P =. 005) but not nonkeratinizing ( P =. 240) or undifferentiated ( P =. 390) NPC. Substandard radiation dosing of <60 Gy and <30 fractions were associated with inferior OS (both P <. 001). Conclusions: NPC survival is dependent on a variety of clinical/sociodemographic factors. Stage‐specific treatments with optimal OS include CRT or RT for stages I to II and CRT for stage III to IV. The large representation of nonendemic histology is valuable, as these cases are not well characterized.