Abstract
BackgroundThere is ongoing debate about surgery of primary site in nasopharyngeal carcinoma patients.Methods3919 patients with nasopharyngeal carcinoma identified in the SEER registry between 2004 and 2013. The benefit of surgery of primary nasopharynx tumor site on overall and cancer-specific survival was assessed by risk-adjusted multivariate Cox proportional hazard regression and propensity score matching modeling.ResultsSurgery was marginally associated with better overall survival (hazard ratio (HR) = 0.816, 95% CI 0.656–1.015, p = 0.07) and cancer-specific survival (HR = 0.749, 95% CI 0.552–1.018, p = 0.06) in the propensity score model. Among 398 cases who underwent primary site surgery, 282 (70.85%) received local tumor excision and 79 (20.31%) received pharyngectomy. Local tumor excision and pharyngectomy had almost the same effect on survival in propensity score matching analysis. The benefit was significant in subgroups of white, age <60 year, and patients with T3, N1, M0, AJCC stage III, or moderately differentiated tumors. Further survival analysis showed surgery to promote survival in both radiotherapy and non-radiotherapy patients.ConclusionThis is the first population-based analysis using propensity score model to provide evidence of a positive impact of surgery on survival in nasopharyngeal carcinoma. Moreover, surgery demonstrated the significant benefit in subgroups of patients with specific clinical characteristics.
Highlights
There is ongoing debate about surgery of primary site in nasopharyngeal carcinoma patients
American Joint Committee on Cancer (AJCC) TNM staging for nasopharyngeal carcinoma (7th ed., 2010), stage is accepted as prognostically important [6]
Database and cohort definition The SEER*Stat database, which was released by the Surveillance Research Program at National Cancer Institute (NCI) in 2016, was used as the data source in the present study [17]. 10,193 patients diagnosed as nasopharyngeal carcinoma (The 3rd edition of International Classification of Diseases for Oncology (ICD-O-3)/World Health Organization (WHO) 2008 and Behavior code ICD-O-3: malignant) were identified in the SEER 18 Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2015 Sub (1973–2013 varying) incidence database
Summary
There is ongoing debate about surgery of primary site in nasopharyngeal carcinoma patients. Nasopharyngeal carcinoma is a rare type of head and neck cancer. It is uncommon in countries other than Asia [1]. In the US, nasopharyngeal carcinoma has been seen. Nasopharyngeal carcinoma has a high propensity to metastasize to distant sites, and poses a significant risk for isolated local recurrences after radiation for locally advanced disease [3, 4]. American Joint Committee on Cancer (AJCC) TNM staging for nasopharyngeal carcinoma (7th ed., 2010), stage is accepted as prognostically important [6]. Relative 5-year survival rates for stage I, II, III and IV patients were 72, 64, 62 and 38%, respectively
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