Cancer Res Treat.  2019 Oct;51(4):1259-1268. 10.4143/crt.2018.652.

Subdivision of Nasopharyngeal Carcinoma Patients with Bone-Only Metastasis at Diagnosis for Prediction of Survival and Treatment Guidance

  • 1Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,
  • 2Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China.


The purpose of this study was to subdivide M1 stage nasopharyngeal carcinoma (NPC) patients with bone-only metastases for prognosis prediction while identifying the treatment effect of locoregional radiotherapy (LRRT) and metastasis radiotherapy (MRT) among patients with different risk.
From November 2006 to October 2016, a total of 226 patients with bone-only metastasic NPC were retrospectively enrolled. All patients developed distant lesions before receiving treatment. All potential prognostic factors were considered and the correlation of the M1 subdivisions with overall survival (OS) was determined by Cox regression hazards model. Kaplan-Meier curves were used to appraise survival condition and log-rank testing was used to compare the differences.
The median follow-up time was 33.9 months (range, 3 to 126 months). According to multivariate Cox proportional hazard analysis, the number of metastatic lesions and Epstein-Barr virus (EBV) DNA status after palliative chemotherapy (PCT) were independent prognostic factors for OS. Thus, we subdivided patients into three risk groups according to these two factors. Systemic chemotherapy combined with LRRT may benefit patients in low- and intermediate-risk groups but not in the high-risk group. Further aggressive MRT based on systemic chemotherapy showed no survival benefit in any risk group.
The stratification of NPC patients with bone-only metastasis based on EBV DNA after PCT and the number of metastatic lesions provided promising prognostic value and could aid clinicians in person-specific treatment.


Nasopharyngeal carcinoma; Metastasis; Epstein-Barr virus; Radiotherapy; Survival

MeSH Terms

Drug Therapy
Follow-Up Studies
Herpesvirus 4, Human
Neoplasm Metastasis*
Proportional Hazards Models
Retrospective Studies


  • Fig. 1. Flow chart for patient inclusion. NPC, nasopharyngeal carcinoma; SYSUCC, Sun Yat-sen University Cancer Center; mNPC, metastatic nasopharyngeal carcinoma.

  • Fig. 2. (A) Kaplan-Meier overall survival curves in 226 patients with bone-only metastatic nasopharyngeal carcinoma. Patients grouped by the number of metastatic lesions by Epstein-Barr virus (EBV) DNA after palliative chemotherapy (PCT) (B); by combination of lesion numbers and EBV DNA after PCT (C) and by risk stratification (D).

  • Fig. 3. Comparison of overall survival of patients in the locoregional radiotherapy (LRRT) and non-LRRT group: low-risk patients (A), intermediate-risk patients (B), and high-risk patients (C). Comparison of overall survival in patients in the metastasis radiotherapy (MRT) and non-MRT group: low-risk patients (D), intermediate-risk patients (E), and high-risk patients (F).

  • Fig. 4. Adjusted hazard ratios (HRs) for overall survival stratified by risk group and locoregional radiotherapy (LRRT) (A) or metastasis radiotherapy (MRT) (B) in patients with bone-only metastatic nasopharyngeal carcinoma. The low-risk group not combined with LRRT/MRT was the reference group (HR, 1). The adjusted variables were age, sex, T category, N category, and pre-treatment Epstein-Barr virus DNA.



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