A retrospective study of 606 cases of nasopharyngeal carcinoma with or without oropharyngeal candidiasis during radiotherapy

PLoS One. 2017 Aug 10;12(8):e0182963. doi: 10.1371/journal.pone.0182963. eCollection 2017.

Abstract

Background: To evaluate the clinical characteristics, treatment-related toxicities and survival in patients with nasopharyngeal carcinoma (NPC) with or without oropharyngealcandidiasis (OPC) during radiotherapy.

Methods: The current study was conducted with NPC patients undergoing radiotherapy at Sun Yat-Sen University Cancer Center between June 2011 and May 2012. A clinical diagnosis of candidiasis was determined on the basis of a positive potassium hydroxide (KOH) test and the presence of pseudomembranous (white) form of candidal overgrowth. The Cox proportional hazard regression model was used to test the association of OPC and related survival rates.

Results: Compared with the non-OPC group, the OPC group had significantly increased occurrence rates of grade 3-4 mucositis (14.5% vs. 7.4%, P = 0.049), anaemia (11.3% vs. 4.4%, P = 0.020), hepatotoxicity (4.8% vs. 1.1%, P = 0.021) and critical weight loss (85.5% vs. 56.6%, P<0.001) during radiotherapy. The OPC group had a significantly lower disease-free survival (DFS) (70.9% vs. 82.6%, P = 0.012), mainly as a result of a reduction in locoregional relapse-free survival (LRFS) (87.0%vs. 94.9%, P = 0.025). After stratification by T stage, the 5-year DFS in T3-4 patients were 82.0% and 68.8% in non-OPC and OPC groups, respectively (P = 0.022). Multivariate analyses indicated that OPC was a prognostic factor for LRFS and DFS.

Conclusions: OPC during radiotherapy may worsen the nutritional status of NPC patients according to weight loss and anaemia, leading to a negative impact on 5-year locoregional relapse-free survival and disease-specific survival. Further investigations are needed to explore whether prevention and treatment of OPC during radiotherapy will be useful.

MeSH terms

  • Adult
  • Candida / isolation & purification
  • Candidiasis / complications*
  • Candidiasis / diagnosis
  • Carcinoma / complications*
  • Carcinoma / diagnosis
  • Carcinoma / radiotherapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nasopharyngeal Carcinoma
  • Nasopharyngeal Neoplasms / complications*
  • Nasopharyngeal Neoplasms / diagnosis
  • Nasopharyngeal Neoplasms / radiotherapy*
  • Nasopharynx / radiation effects*
  • Prognosis
  • Proportional Hazards Models
  • Radiotherapy / adverse effects
  • Radiotherapy, Intensity-Modulated / adverse effects
  • Retrospective Studies
  • Treatment Outcome

Grants and funding

This study is supported by grants from the Science and Technology Program of of Guangdong Province [grant number 2013B021800141] (http://pro.gdstc.gov.cn/egrantweb/proposal/prp-edit-list?year=&stat_year=&is_lazy_load_data_info=false###); Science and Technology Program of Guangzhou [grant number 2014Y2-00179] (http://www.gzsi.gov.cn/); and Science and Technology Plan Project of International Cooperation of Guangdong Province [grant number 2016A050502011] (http://www.gdstc.gov.cn/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.