A Comprehensive Analysis of Treatment Management and Survival Outcomes in Nasopharyngeal Carcinoma

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.

The influence of facility volume on patient treatments and survival outcomes in nasopharyngeal carcinoma

“…It is plausible to hypothesize that favorable outcomes at high‐volume centers may also be attributed to other underlying clinical processes, such as greater access to subspecialized treating radiation and medical oncologists with extensive training, more advanced equipment and technologies, or better compliance with the latest clinical guidelines and evidence‐based practices 24‐28 . Moreover, differences in the expertise of dosimetrists and medical physicists may have contributed to survival disparities due to variations in radiation quality, which have been shown to be particularly influential in treatment outcomes for NPC 7 . In our NCDB patient population, we found lower radiotherapy doses and higher treatment fractions to be more common among low‐ and intermediate‐volume facilities.…”

“…The 2004–2015 NCDB was queried for all patients diagnosed with NPC using International Classification of Disease for Oncology, 3rd Edition (ICD‐O‐3) topography codes for the nasopharynx primary site (C11.0‐C11.9) and NPC histology/behavior codes (8070/3, 8071/3, 8072/3, 8073/3, 8020/3, 8021/3, 8082/3, 8010/3). Inclusion and exclusion criteria were in‐line with a previous NPC study by this group 7 . Specifically, exclusion criteria for this study included patients with multiple primary malignancies; those receiving treatment outside the reporting facility; subjects receiving palliative care, hormone therapy, or immunotherapy; and patients with unspecified treatments, <3 months of follow‐up, or unknown follow‐up time or outcomes.…”

“…Since NPC is often diagnosed late into its disease course, patients are commonly seen with large primary tumors, locoregional advanced stages, and nodal involvement 5,6 . Therefore, recent large‐population studies have estimated modest 5‐year and 10‐year overall survival (OS) rates of 59%–63% and 48%–50%, respectively 7‐9 . A variety of clinical and socioeconomic factors have been noted to significantly influence OS in NPC, including age, race, histology, American Joint Committee on Cancer (AJCC) stage, and treatment type 7,10‐12 .…”

“…Therefore, recent large‐population studies have estimated modest 5‐year and 10‐year overall survival (OS) rates of 59%–63% and 48%–50%, respectively 7‐9 . A variety of clinical and socioeconomic factors have been noted to significantly influence OS in NPC, including age, race, histology, American Joint Committee on Cancer (AJCC) stage, and treatment type 7,10‐12 . A Taiwan‐based study based on patients with NPC treated between 1998 and 2000 suggested that hospitals' caseload correlated positively with survival rates, 13 warranting further investigation of this relationship among US‐based patients in recent years.…”

Open and endoscopic surgery improve survival for squamous and nonsquamous cell nasopharyngeal carcinomas: An NCDB cohort study

“…One National Cancer Database (NCDB) study showed that patients who underwent surgery and chemoradiation had improved overall survival compared with those receiving chemoradiation alone for stage IVA cancers but not other stages. 10 However, effects of surgical subtype and histology were not evaluated in the study. Recently, published studies using NCDB of the larynx and hypopharynx have also demonstrated improved overall survival in patients treatment with minimally invasive surgery compared with radiation.…”