Abstract
Background The prognosis of metastatic nasopharyngeal carcinoma (mNPC) is highly heterogeneous. As a special stage of distant metastasis of mNPC, quite a few oligometastatic NPC (omNPC) patients can still achieve a long-term survival after treatment. However, there is no uniform standard for the definition of omNPC until now. Methods We retrospectively analyzed the survival data of 191 patients with de novo mNPC at the Affiliated Cancer Hospital and Institute of Guangzhou Medical University between 2010 and 2017 and specifically analyzed the clinical outcomes associated with the number of metastatic organs/lesions and tried to find a cohort with relatively better prognosis to define as omNPC. Results The median overall survival (OS) of the entire group of patients was 21.5 months (95% CI 15.0–28.0), and the 1-year, 2-year, and 3-year OS rates were 72.2%, 46.1%, and 34.3%, respectively. Multiple-organ metastases (P < 0.001) and >5 metastatic lesions (P < 0.001) were adverse influencing factors of prognosis, and the number of metastatic lesions (P < 0.001) was the independent factor influencing the prognosis of de novo mNPC. The overall survival (OS) and progression-free survival (PFS) of patients with ≤5 metastatic lesions were significantly better than those of patients with >5 metastatic lesions. Conclusion Patients with ≤5 metastatic lesions presented a better survival, and this criterion may be a definition standard for the de novo omNPC.
Highlights
Nasopharyngeal carcinoma (NPC) is a head and neck malignant tumor with a high incidence in South China and Southeast Asia, and the main pathological type is squamous cell carcinoma [1]
With the wide application of intensity-modulated radiotherapy (IMRT) and positron emission tomography(PET-) computed tomography (CT) in tumor diagnosis and staging, the early diagnosis rate and overall survival (OS) rate of NPC have been further improved for the 5-year OS reaches up to 85% for early and locally advanced NPC after treatment [4, 5], but the prognosis of metastatic nasopharyngeal carcinoma (mNPC) is still highly heterogeneous [6, 7]
The definition criteria for oligometastasis are not exactly the same for different tumor types, and most studies defined oligometastasis as ≤5 metastases. e guidelines for metastatic colorectal cancer published by the European Society of Oncology (ESMO) in 2016 pointed out that oligometastatic colorectal cancer usually refers to a disease state with metastatic organs ≤2 and number of metastases ≤5 [16]
Summary
Nasopharyngeal carcinoma (NPC) is a head and neck malignant tumor with a high incidence in South China and Southeast Asia, and the main pathological type is squamous cell carcinoma [1]. 4%–10% of NPC patients have distant metastasis at initial diagnosis (stage IVB, American Joint Committee on Cancer (AJCC), 8th edition) [7, 8], and mNPC is generally considered incurable and has a poor overall prognosis, with a median OS of approximately 20 months [6]. There is still no consensus on the specific definition of omNPC, and the influence of the number of metastatic organs and lesions on the prognosis of NPC has not yet been clearly evaluated Based on these backgrounds, this study explored the definition of de novo omNPC and the related prognostic factors, hoping to provide a reference for the clinical formulation of reasonable individualized treatment options. Us, we trend to support the hypothesis that ≤5 metastatic lesions might be a feasible standard for defining the de novo omNPC According to this definition, this study included 94 patients with oligometastasis and 97 patients with extensive metastasis. Among the 94 patients with oligometastasis, 19 patients have received local treatment for distant metastases, including 2 cases of liver radiofrequency ablation, 1 case of local radiotherapy for lung metastases, and 4 cases of local radiotherapy for metastatic lymph nodes
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