Prognostic value of hypertension in patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy

Abstract

Purpose To investigate the prognostic value of hypertension in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). Methods and Materials: A total of 1057 patients with nonmetastatic, histologically proven NPC who were treated with IMRT were retrospectively reviewed. Associations between hypertension and overall survival (OS), loco-regional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS) were estimated by Cox regression. Results Among 1057 patients, 94 (8.9%) had hypertension. Compared to normotensive patients, the hypertensive patients were generally older, had higher body fat, were more likely to be alcohol consumers, were more often in the early stage and usually received radiotherapy alone. Compared to normotension, hypertension was significantly associated with worse OS (hazard ratio (HR), 2.20; 95% confidence interval (CI), 1.41–3.42; P = 0.000), LRRFS (HR, 2.13; 95% CI, 1.12–4.03; P = 0.021) and DMFS (HR, 1.82; 95% CI, 1.09–3.05; P = 0.023) after adjusting for covariates. Moreover, the association with OS remained unchanged regardless of smoking, body mass index (BMI), N stage and chemotherapy, whereas it was limited in the subgroup of patients who were older than 50 years, male, not alcohol consumers, in advanced T stage and in advanced clinical stage. Compared with treated hypertension, untreated hypertension was associated with increased risks for death (P = 0.221; HR, 1.88; 95% CI, 0.69–5.15), locoregional recurrence (P = 0.073; HR, 3.29; 95% CI, 0.89–12.09) and distant metastasis (P = 0.640; HR, 1.30; 95% CI, 0.44–3.83). The patients with more severe levels of hypertension had worse survival and locoregional control, although there was no statistically significant difference (P > 0.05). Conclusions Hypertension is an independent adverse prognostic factor in NPC patients treated with IMRT. The NPC patients with untreated hypertension had similar survival as those with treated hypertension. The severity of hypertension did not influence the prognosis.