A Comprehensive Analysis of Treatment Management and Survival Outcomes in Nasopharyngeal Carcinoma

Khodayar Goshtasbi; Brandon M Lehrich; Jack L Birkenbeuel; Arash Abiri; Jeremy P Harris; Edward C Kuan

doi:10.1177/0194599820973241

A Comprehensive Analysis of Treatment Management and Survival Outcomes in Nasopharyngeal Carcinoma

Otolaryngol Head Neck Surg. 2021 Jul;165(1):93-103. doi: 10.1177/0194599820973241. Epub 2020 Nov 24.

Authors

Khodayar Goshtasbi¹, Brandon M Lehrich^{1

2}, Jack L Birkenbeuel¹, Arash Abiri¹, Jeremy P Harris³, Edward C Kuan¹

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Orange, California, USA.
² Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, Pennsylvania, USA.
³ Department of Radiation Oncology, University of California-Irvine, Orange, California, USA.

PMID: 33231508
DOI: 10.1177/0194599820973241

Abstract

Objectives: To comprehensively investigate nasopharyngeal carcinoma (NPC) treatment, overall survival (OS), and the influence of clinical/sociodemographic factors on outcome.

Study design: Retrospective database study.

Setting: National Cancer Database.

Methods: The 2004-2015 National Cancer Database was queried for all patients with NPC receiving definitive treatment. Log-rank tests and Cox proportional hazards models were used for statistical analyses.

Results: A total of 8260 patients with NPC were included (71.4% male; 42.5% with keratinizing histology; mean ± SD age, 52.1 ± 15.1 years), with a 5-year OS of 63.4%. Multivariate predictors of mortality included age ≥65 years (hazard ratio [HR], 1.81; P < .001), Charlson/Deyo score ≥1 (HR, 1.27; P = .001), American Joint Committee on Cancer clinical stage III to IV (HR, 1.85; P < .001), and government insurance or no insurance (HR, 1.53; P < .001). Predictors of survival included female sex (HR, 0.82; P = .002), Asian/Pacific Islander race (HR, 0.74; P < .001), nonkeratinizing/undifferentiated histology (HR, 0.79; P = .004), and receiving treatment at academic centers (HR, 0.87; P = .02). Chemoradiotherapy (CRT) demonstrated improved OS as compared with radiotherapy (RT) only for stage II (P = .006) and stage III (P = .005) and with RT or chemotherapy only in stage IVA NPC (P < .001). When compared with CRT alone, surgery plus CRT provided OS benefits in keratinizing (P = .013) or stage IVA (P = .030) NPC. When compared with RT, CRT provided OS benefits in keratinizing (P = .005) but not nonkeratinizing (P = .240) or undifferentiated (P = .390) NPC. Substandard radiation dosing of <60 Gy and <30 fractions were associated with inferior OS (both P < .001).

Conclusions: NPC survival is dependent on a variety of clinical/sociodemographic factors. Stage-specific treatments with optimal OS include CRT or RT for stages I to II and CRT for stage III to IV. The large representation of nonendemic histology is valuable, as these cases are not well characterized.

Keywords: NCDB; NPC; chemoradiotherapy; nasopharyngeal carcinoma; overall survival; radiation oncology.

MeSH terms

Adult
Aged
Combined Modality Therapy
Databases, Factual
Female
Humans
Male
Middle Aged
Nasopharyngeal Carcinoma / mortality*
Nasopharyngeal Carcinoma / pathology
Nasopharyngeal Carcinoma / therapy*
Nasopharyngeal Neoplasms / mortality*
Nasopharyngeal Neoplasms / pathology
Nasopharyngeal Neoplasms / therapy*
Neoplasm Staging
Proportional Hazards Models
Retrospective Studies
Socioeconomic Factors
Survival Rate
Treatment Outcome