Comparison of Prognosis Between Juvenile and Adult Nasopharyngeal Carcinoma: A Propensity Score-Matched Analysis

Chuanben Chen; Qinyan Chen; Yuanji Xu; Wei Zheng; Zhizhong Lin; Zijie Wu; Wangzhong Ye; Xinyi Huang; Xiurong Lin; Penggang Bai

doi:10.2147/CMAR.S260402

Comparison of Prognosis Between Juvenile and Adult Nasopharyngeal Carcinoma: A Propensity Score-Matched Analysis

Cancer Manag Res. 2020 Sep 18:12:8613-8621. doi: 10.2147/CMAR.S260402. eCollection 2020.

Authors

Chuanben Chen^#¹, Qinyan Chen^#², Yuanji Xu¹, Wei Zheng¹, Zhizhong Lin¹, Zijie Wu², Wangzhong Ye², Xinyi Huang², Xiurong Lin¹, Penggang Bai¹

Affiliations

¹ Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, People's Republic of China.
² Graduate School, Fujian Medical University, Fuzhou 350000, Fujian Province, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: To investigate whether juvenile patients with nasopharyngeal carcinoma (NPC) in China have better prognosis than their adult counterparts in the intensity-modulated radiation therapy (IMRT) era, after controlling for potential confounding variables.

Methods: Data pertaining to 1139 patients with newly diagnosed NPC without metastasis, who were treated with IMRT at our hospital, were retrospectively analyzed. Of these, 60 patients were juvenile (age ≤18 years) diagnosed between January 2003 and December 2018, while 1079 patients were adults (≤65 years) diagnosed between January 2013 and December 2014. To minimize the influence of selection and confounding bias, 1:2 propensity score matching (PSM) was used. Overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were estimated using the Kaplan-Meier method and between-group differences assessed using the Log rank test. The long-term toxicity of the juvenile patients was evaluated according to the criteria of the Radiation Therapy Oncology Group (RTOG) and the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

Results: Five-year OS of juvenile and adult patients were 88.07% and 85.08%, respectively. Before PSM, OS, PFS, DMFS, or LRFS were comparable in the two groups (all P > 0.05). After PSM, OS, DFS, and LRFS in the juvenile group were markedly longer than that in adults (P = 0.005, P = 0.027, and P = 0.024, respectively). With respect to long-term toxicity, the most common adverse effects in juvenile patients were cervix fibrosis, ototoxicity, and xerostomia. However, except for two patients who developed grade 3 ototoxicity, all adverse effects were within grade 2.

Conclusion: In the IMRT era, juvenile Chinese patients with NPC had better 5-year OS, DFS, and LRFS than their adult counterparts. The adverse events in the juvenile cohort were relatively mild; however, the risk of severe ototoxicity should not be neglected.

Keywords: intensity-modulated radiotherapy; juvenile nasopharyngeal carcinoma; prognosis.

Grants and funding

This project was funded by Joints Funds for the Innovation of Science and Technology, Fujian Province (Grant number: 2018Y9107, 2019Y9034), Natural Science Foundation of Fujian Province, China (Grant number: 2019J01201, 2019J05140), Fujian Provincial Health Technology Project (Grant number: 2018-CX-11, 2018-ZQN-19, 2019-ZQN-14), Startup for Scientific Research, Fujian Medical University (Grant number: 2018QH1222), and Science and Technology Program of Fujian Province, China (Grant number: 2018Y2003).