Abstract
The treatment for patients with stage IVc nasopharyngeal carcinoma (NPC) at diagnosis was still controversial. In this study, we tried to build a prognostic score model and optimize the treatment for the patients. The prognostic model was based on the primary cohort involving 289 patients from 2002 to 2011 and the validation involving another 156 patients from 2012 to 2015.The prognostic model was built based on the hazard ratios of significant prognostic factors for overall survival (OS). By multivariate analysis, factors associated with poor OS were Karnofsky performance score ≤70, liver metastases, multiple-organ metastases, ≥2 metastatic lesions, lactate dehydrogenase >245 IU/I and poor response to chemotherapy (all P < 0.01). Based on these prognostic factors, patients were divided into the low-risk (0–2 points), intermediate-risk (3–6 points) and high-risk (≥7 points) groups. Five-year OS rates for the low-, intermediate- and high-risk groups were 49.3%, 9.7% and 0.0%, respectively (P < 0.01). Furthermore, loco-regional radiotherapy was associated with significantly better OS in low- and intermediate-risk patients, but not in high-risk patients. These results demonstrated that the prognostic score model based on six negative factors can effectively predict OS in patients with stage IVc NPC at diagnosis. Loco-regional radiotherapy may be beneficial for low- and intermediate-risk patients, but not for high-risk patients.
Highlights
The epithelial malignancy nasopharyngeal carcinoma (NPC) is disproportionally common in Southern China[1]
The inclusion criteria were: (1) patients with pathologically confirmed WHO type II or III NPC; (2) diagnosed with distant metastasis based on clinical symptoms, imaging finding and follow-up data; (3) who received at least one anti-cancer treatment including chemotherapy and/or radiotherapy
The characteristics of 289 patients in the primary cohort and 156 patients in the validation cohort are summarized in Table 1.Among the patients in the primary cohort,median age was 52-years-old
Summary
The epithelial malignancy nasopharyngeal carcinoma (NPC) is disproportionally common in Southern China[1]. The presence of distant metastasis is the most significant negative prognostic factor in NPC; median overall survival (OS) for patients with distant metastasis at diagnosis ranges from only 9 to 20 months[4,5,6,7]. The American Joint Committee on Cancer (AJCC) staging system classifies patients with distant metastasis as a single group, which does not enable stratification of prognosis[13,14]. It is necessary to create a risk-stratification system that enables the survival outcomes of patients with stage IV NPC at initial diagnosis to be predicted; this would have value from both a therapeutic and research point of view
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