Prognostic value of pretreatment and recovery duration of cranial nerve palsy in nasopharyngeal carcinoma

Qing Zhang,Yan-Xian Li,Hai-Qiang Mai,Jian Sun,Jing Yang,Wen-Jin Huang,Rui Sun,Hao-Yuan Mo

doi:10.1186/1748-717x-7-149

Abstract

BackgroundThe purpose of this study was to evaluate the prognostic value of cranial nerve (CN) palsy in nasopharyngeal carcinoma (NPC) patients.MethodsA retrospective analysis was performed on CN involvement using medical records of 178 consecutive patients with histologically diagnosed, non-disseminated NPC.ResultsIn 178 NPC patients with CN palsy, the 5-year survival rates were as follows: overall survival (OS), 61.0%; disease-specific survival (DSS), 69.6%; local relapse-free survival (LRFS), 75.2%; distant metastasis-free survival (DMFS), 73.4%; and disease-free survival (DFS), 55.3%. Significant differences were observed in the 5-year OS rates between patients with single and multiple CN palsy (69.8% vs. 54.3%; P = 0.033) and the OS rates between patients with different pretreatment durations (68.7% vs. 43.3%, P = 0.007). However, no significant differences were observed in OS, DSS, LRFS and DFS rates between patients with upper and lower CN palsy (P = 0.581, P = 0.792, P = 0.729 and P = 0.212, respectively). The results showed that recovery duration was an independent prognostic factor for OS (HR = 2.485; P < 0.001), DSS (HR = 2.065; P = 0.016), LRFS (HR = 3.051; P = 0.001) and DFS (HR = 2.440; P < 0.001).ConclusionsRecovery duration is an independent prognostic factor for NPC patients with CN palsy and is related to recurrence, which leads to poor survival. Recovery duration requires close surveillance and different treatment regimens.

Highlights

The purpose of this study was to evaluate the prognostic value of cranial nerve (CN) palsy in nasopharyngeal carcinoma (NPC) patients
Significant differences were observed in the 5-year overall survival (OS) rates (69.8% vs. 54.3%; P = 0.033) between the two groups with single and multiple CN palsy, but no significant differences were observed for disease-specific survival (DSS) (76.1% vs. 64.5%; P = 0.085), local relapse-free survival (LRFS) (73.2% vs. 76.8%; P = 0.783), distant metastasis-free survival (DMFS) (76.9% vs. 70.5%; P = 0.384) or disease-free survival (DFS) (59.0% vs. 52.7%; P = 0.317) rates between the two groups (Figure 1)
The following parameters, which could potentially influence patient prognosis, were included in the Cox proportional hazards model for multivariate analysis: age (>median age vs. ≤median age), sex, N classification, radiotherapy dose (>70 Gy vs. ≤70 Gy), chemotherapy, and CN palsy

Summary

Introduction

The purpose of this study was to evaluate the prognostic value of cranial nerve (CN) palsy in nasopharyngeal carcinoma (NPC) patients. Cranial nerve (CN) palsy in nasopharyngeal carcinoma (NPC) is the result of an adjacent extension of the primary tumor. Cranial nerve involvement is considered an unfavourable prognostic factor for NPC patients, and those with CN palsy have been classified as T4 according to. The diagnosis of CN palsy mostly depends on clinical symptoms and a physical examination, and magnetic resonance imaging (MRI) has proven to be an important tool for defining CN involvement in NPC [4,5,6]. CN palsy frequently accompanies skull-base invasion in upper CN palsy and carotid sheath erosion in lower CN palsy. Skull-base invasion can approach from basicranial to intracranial or orbital sites, and carotid sheath erosion will extracranially involve lower CN palsy. Previous studies have focussed only on survival rates and imaging diagnoses in NPC patients with and without CN palsy, and those studies did not indicate the prognostic value of the pretreatment or recovery durations in NPC patients with CN palsy

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