Survival for nasopharyngeal cancer with distant metastatic disease at presentation

Abstract

e17004 Background: Nasopharyngeal carcinoma (NPC) is a unique form of head and neck cancer, with distinct epidemiology and sensitivity to chemotherapy (CT) and radiation (RT). Long-term survival has been reported for selected patients with metastatic disease. However, given its rarity in the Western Hemisphere, data is limited to case series. We used the Surveillance Epidemiology and End Results (SEER) database to determine factors that correlated with prolonged survival in patients with metastatic NPC at presentation. Methods: The SEER database was searched for patients with NPC who have distant metastatic disease at presentation, defined as extent of disease (EOD10) code 85, aged 20 or older, diagnosed between 1988 and 2003. Survival probability was estimated by Kaplan-Meier method and covariate effects were examined using log-rank tests. Parameters evaluated include age, gender, race, tumor grade, and use of RT. Results: Among the 2,610 patients with NPC in SEER, 177 (6.7%) were identified with distant metastatic disease at presentation. Five patients were excluded from subsequent analysis because RT data was not available. RT was administered to 114 patients (66.3%). Median survival was 9 months (95%CI: 7–13 months) and 5-year overall survival (OS) of 20% (95%CI: 14–26%). Outcomes were significantly improved for patients treated with RT compared to those not receiving it, with the 5-year OS rates of 28% versus 3% (p < 0.0001) respectively. Other factors associated with improved survival included non-white race (p = 0.01) and younger age (p < 0.0001). Conclusions: Although SEER lacks information on performance status, site of metastases, and CT use, our data shows that selected patients with metastatic NPC may achieve prolonged survival, particularly if RT is used. It is unclear whether RT is a determinant of better OS or an epiphenomenon. No significant financial relationships to disclose.