Metastatic Patterns and Prognosis of de novo Metastatic Nasopharyngeal Carcinoma in the United States

Abstract

Objective: To evaluate the distant metastatic patterns and prognostic factors for overall survival (OS) and cancer-specific survival (CSS) in de novo metastatic nasopharyngeal carcinoma (mNPC) using the Surveillance, Epidemiology, and End Results (SEER) database. Methods: Patients with de novo mNPC who had been diagnosed between 2004 and 2016 were identified from the SEER database. Kaplan-Meier analysis was used to calculate OS and CSS. Log-rank tests were employed to measure survival variation among subgroups. Individual predictors of CSS and OS were examined using Cox proportional-hazards regression models in patients with de novo mNPC. Results: We evaluated 224 patients with de novo mNPC who matched our inclusion criteria. Three-year CSS and OS for the whole cohort was 29.8% and 27.9%, respectively. Univariate analysis indicated that CSS and OS were influenced by age, histology, radiotherapy, chemotherapy, and liver metastasis. Neither the number of metastatic sites nor their specific location in bone, lungs, distant lymph nodes or brain significantly affected CSS or OS. The aforementioned independent prognosticators continued to significantly influence survival following multivariate analysis. Taking distant metastasis without liver involvement as a reference, liver metastasis was associated significantly with shorter OS at a hazard ratio (HR) of 1.581 (P = .021) and CSS at a HR of 1.643 (P = .016). Older age, keratinizing squamous cell carcinoma, no chemotherapy, and no radiotherapy were also prognosticators for poor OS (P < .05). Similar results were documented for CSS (P < .05). Conclusion: For patients with de novo mNPC, liver metastasis is an independent prognosticator for inferior CSS and OS.

A nonendemic analysis of the patterns and prognosis of de novo metastatic nasopharyngeal carcinomas in older patients aged ≥ 65 years

“…Chemotherapy at the IVC stage improved OS (HR: 0.40, 95% CI: 0.25–0.65, and p < 0.001) but did not significantly affect CSS. Furthermore, chemotherapy was significantly associated with improved OS in this study, which is consistent with other studies, which reported that chemotherapy may improve the OS of older patients with de novo metastatic NPC 16 , 29 . Unfortunately, radiation was not found to be an independent prognostic factor and only improved OS.…”

“…The paper reported that single organ metastasis had a better prognosis than multiple organ metastasis 27 . Contrary to this finding, the number of organs with metastasis did not affect the prognosis, but the number of metastatic lesions did, and patients with multiple lesions had a worse prognosis than those with single lesions 16 , 19 , 30 . In our study, patients with single organ metastasis did not have better survival, which may be because they may exhibit more metastases within the organ.…”

“…Simultaneously, curves did not crossover and were separate for OS; therefore, more samples may be needed to better study the survival curves. Unlike previous results, Yali et al indicated that TN stage did not significantly affect the survival of patients with metastatic NPC in nonendemic areas 16 . Some previous studies have reached a similar conclusion, indicating that N stage may be an independent prognostic factor related to survival 17 , 18 .…”

“…Jun Ma et al noted that the size of the lung metastases was an independent prognostic factor for survival in endemic patients 31 . In contrast, Yali reported that liver metastasis had adverse effects on survival, and lung metastasis was not statistically significant on survival 16 . Similarly, lung metastasis may be characterized by small and infrequent lesions.…”

The patterns of distant metastasis and prognostic factors in patients with primary metastatic Ewing sarcoma of the bone

“…In recent years, the patterns of DM as prognostic indicators in de novo stage IV metastatic cancers have been investigated increasingly, which provided additional information for clinical practice [16] , [17] , [18] . However, the progression of understanding the epidemiology of primary metastatic ES is limited.…”