Clinical characteristics and survival outcomes of ascending, descending and mixed types of nasopharyngeal carcinoma in the non-endemic areas of china: A propensity score matching analysis.

Yixin Fan,Qin Yang,Wenqiang Guan,Jinyi Lang,Le Kang,Rui Huang,Peng Zhang,Stefan (Yujie) Lin,Shun Lu,Yanqiong Song

doi:10.1002/cam4.3537

Abstract

PurposeTo compare the clinical characteristics and survival outcomes of patients with ascending type (type A), descending type (type D), and mixed type (type AD) of nasopharyngeal carcinoma (NPC) in non‐endemic areas.Materials and methodsThe cohort included 628 patients diagnosed with type A, type D, and type AD of NPC between January 2009 and December 2014. Type A was defined as T3‐4 N0‐1, type D as T0‐1 N2‐3, and type AD as T3‐4 N2‐3. Propensity score matching (PSM) was performed to balance clinical factors and match patients. Kaplan‐Meier methods and Cox proportional hazards models were used to evaluate the impact of different NPC types on survival outcomes.ResultsThere were 145 patients with type A, 194 with type D, and 289 with type AD. However, after PSM, there were only 130 patients with each type. Compared with patients with type A, those with type D had lower 5‐year disease‐specific survival (96.9% vs 91.5%) and distant metastasis‐free survival (92.3% vs 77.7%) and higher local relapse‐free survival (88.5% vs 96.9%) (p < 0.05 for all). Patients with type AD may have an increased risk of disease progression (progression‐free survival, 56.9% vs 74.6% and 66.2%) and death (overall survival [OS], 76.9% vs 85.4% and 85.4%) (p < 0.05 for all) compared to patients with the other two types of tumors.We further analyzed the metastasis trend. Similar metastasis patterns were observed in types AD and D, and types AD and A had similar recurrence trends. The mortality rate of patients with types AD and D in the first 3 years after metastasis was remarkably higher than that of patients with type A.ConclusionsIn non‐endemic areas of China, metastases and recurrence patterns differed across tumor types. Type AD has the worst OS, and the clinical process is more radical. Type D has a lower recurrence rate, higher metastasis, and disease‐related mortality rates, and poorer prognosis after metastasis than type A.

Highlights

Nasopharyngeal carcinoma (NPC) is a rare disease with obvious regional characteristics.[1]
Patients with type D tumors had a higher risk of metastasis within 5 years (DMFS, 77.7% vs 92.3%; p < 0.05; Figure 1C) than patients with type A tumors, while there was a smaller proportion of patients with type D tumors who had local recurrence (LRFS, 88.5% vs 96.9%; p < 0.05; Figure 1D)
To the best of our knowledge, this is the largest clinical retrospective study in non-endemic areas that compared the three types of NPC in 628 enrolled with stage III–IV patients stratified by clinical characteristics, survival outcomes, recurrence patterns, and metastasis

Summary

| INTRODUCTION

Nasopharyngeal carcinoma (NPC) is a rare disease with obvious regional characteristics.[1]. The aforementioned study provided detailed clinical biological behaviors and risk factors related to type A and D NPC. The clinical biological behaviors of the three types of NPC in non-endemic areas remain unclear. Based on the aforementioned premise, we need to further explore whether this type of approach can better guide the prognosis of NPC cases. We primarily analyzed the clinical characteristics and survival results of the three types of NPC in the non-endemic areas. We used propensity score matching (PSM) and conducted a retrospective study comparing survival outcomes of patients with the three types of NPC in the non-endemic areas. This study aimed to explore the time trend of distant metastasis and recurrence of the three types of NPC and further compare the survival after distant metastasis

| MATERIALS AND METHODS

| RESULTS

Findings

| DISCUSSION