Cervical nodal necrosis is an independent survival predictor in nasopharyngeal carcinoma: an observational cohort study
Received 14 April 2016
Accepted for publication 15 August 2016
Published 1 November 2016 Volume 2016:9 Pages 6775—6783
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Manfred Beleut
Peer reviewer comments 3
Editor who approved publication: Dr William Cho
Yangkun Luo,1 Jing Ren,2 Peng Zhou,2 Yang Gao,3 Guangquan Yang,1 Jinyi Lang1
1Department of Radiation Oncology, 2Department of Radiology, Sichuan Cancer Hospital, Chengdu, 3Department of Radiation Oncology, Zigong No 4 People’s Hospital of Sichuan Province, Zigong, Sichuan, People’s Republic of China
Purpose: 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.
Patients and methods: 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.
Results: 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%, P=0.015) and OS (59.5% vs 75.8%, P=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 (P=0.046 and P=0.005) and with poorer PFS among patients with T3 or III stage (all P=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; P=0.014; OS: adjusted hazard ratio, 1.754; 95% CI: 1.061–2.899; P=0.028).
Conclusion: 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.
Keywords: nasopharyngeal carcinoma, cervical nodal necrosis, prognostic factor, chemotherapy, intensity-modulated radiotherapy
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