Pretreatment prognostic factors of survival and late toxicities for patients with nasopharyngeal carcinoma treated by simultaneous integrated boost intensity-modulated radiotherapy

Abstract

BackgroundTo scrutinize the pretreatment prognosticators on survival and late toxicities in a homogenous cohort of nasopharyngeal carcinoma (NPC) patients treated by simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT).MethodsA total of 219 non-distant metastatic NPC patients consecutively treated by SIB-IMRT at a single institute were collected. The pretreatment factors including the socio-demographic variables, TNM stages, gross tumor volume (GTV), Epstein-Barr virus (EBV)-DNA, and hematologic inflammatory markers were analyzed. Cox model was used to screen the prognostic factors of late toxicities and four survival outcomes including locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), failure-free survival (FFS), and overall survival (OS).ResultsStatistically significant inter-correlations were observed between the values of EBV-DNA, some hematologic inflammatory markers, GTV, and N classification. The 5-year LRRFS, DMFS, FFS, and OS rates were 87.9%, 89.4%, 79.4%, and 81.3%, respectively. Multivariate analysis revealed that advanced N classification (N2–3 vs. N0–1) remained the only significant negative prognosticator for all the four survival outcomes. An increased monocyte percentage and a decreased lymphocyte-to-monocyte ratio were significantly associated with poorer FFS and OS, respectively. Larger GTV was observed to be predictive of poorer LRRFS. Patients with T3–4 (HR: 3.5, 95% CI: 1.0–12.1, p = 0.048) or higher GTV (HR: 1.006, 95% CI: 1.001–1.011, p = 0.027) were associated with higher incidence of radiation neuropathy.ConclusionN classification remains the most significant survival predictor for NPC patients treated by SIB-IMRT after adjusting these biomarkers. GTV impacts not only on locoregional control but also radiation neuropathy.

Merkel Cell Polyoma Viral Load and Intratumoral CD8+ Lymphocyte Infiltration Predict Overall Survival in Patients With Merkel Cell Carcinoma

“…A possible reason for the impaired survival of patients with high viral-load is a missing or ineffective immune response due to immunosuppression or various cancer- and microenvironment-associated mechanisms, including alteration of regulatory T cell function and activation of the PD-1/PD-L1 axis (32, 33). Notably, similar findings have been reported for Epstein-Barr-Virus (EBV) associated nasopharyngeal cancer, where a high EBV-DNA load in the plasma correlated with an impaired outcome (34, 35).…”

Histological subtype remains a prognostic factor for survival in nasopharyngeal carcinoma patients

“…Similar findings have been reported by García‐Lorenzo et al and Burt et al Their conclusions are consistent with our findings. However, many studies have suggested that histological subtype does not influence the survival outcomes of patients with NPC . The reasons for the uncertain relationship between histological subtypes and the prognosis of NPC are presented below.…”

“…However, many studies have suggested that histological subtype does not influence the survival outcomes of patients with NPC. [18][19][20] The reasons for the uncertain relationship between histological subtypes and the prognosis of NPC are presented below. 1) Because of the many classification schemes, it is difficult to compare studies, as the criteria for subclassifying a tumor vary from study to study.…”

Maximal lymph nodal diameter in staging system of nasopharyngeal carcinoma

“…In contrast, Guo et al (7) found that the maximal lymph nodal diameter measured in all the longitudinal, sagittal, and coronal planes was not a useful indicator in predicting the spread potential of NPC patients. It was suggested that the maximal lymph nodal diameter might not represent the tumor burden, which could be replaced by the tumor volume (15,16) and metabolic tumor volume (17)(18)(19)(20).…”