Prognosis and treatment of newly diagnosed nasopharyngeal carcinoma with oligometastases

Abstract

Objective To investigate the prognostic factors and treatment modes for nasopharyngeal carcinoma with oligometastases. Methods A total of 149 patients newly diagnosed with nasopharyngeal carcinoma and oligometastases from 2002 to 2010 were enrolled as subjects. In those patients, 94 had bone metastases, 32 liver metastases, and 22 lung metastases; 51 had only one metastatic site and 98 had 2-5 metastatic sites. All the patients were treated with cisplatinum-based commination chemotherapy. The median number of cycles of chemotherapy was 5(1-12). In those patients, 115 received radiation to the primary tumor and 57 received local radiotherapy to metastatic sites. A survival analysis was performed on clinical characteristics, tumor status, and treatment mode. The Kaplan-Meier method was used to calculate the overall survival (OS) rate. The log-rank test was used to analyze the difference and perform the univariate analysis. The Cox regression model was used for multivariate analysis. Results In all patients, the median OS time was 31 months (2-144 months); the 3-and 5-year OS rates were 52.7% and 37.7%, respectively; 59.7%, 31.5%, and 5.4% of patients had complete response/partial response, stable disease (SD), and progressive disease (PD), respectively. The short-term treatment outcomes were associated with the numbers of metastatic sites and chemotherapy cycles (P=0.01; P=0.00). Liver metastases, a level of lactate dehydrogenase (LDH) higher than 245 IU/L, a poor response to chemotherapy (SD/PD), and no radiotherapy for primary tumor were prognostic factors for poor OS (P=0.00; P=0.00; P=0.00; P=0.01). The 5-year OS rate of patients undergoing radiotherapy for primary tumor was 46.2% and no patients survived more than 5 years without radiotherapy for the primary tumor. Conclusions Patients newly diagnosed with nasopharyngeal carcinoma and oligometastases have relatively good prognosis. A level of LDH higher than 245 IU/L, liver metastases, a poor response to chemotherapy (SD/PD), and no radiotherapy for the primary tumor are negative prognostic factors. Radiotherapy for the primary tumor can further improve the OS in patients newly diagnosed with nasopharyngeal carcinoma and oligometastases. Key words: Nasopharyngeal neoplasms/radiochemotherapy; Ooligometastases; Prognosis