Cancer Res Treat.  2019 Oct;51(4):1449-1463. 10.4143/crt.2018.688.

Patterns of Failure and Survival Trends in 3,808 Patients with Stage II Nasopharyngeal Carcinoma Diagnosed from 1990 to 2012: A Large-Scale Retrospective Cohort Study

• Sun XS
• Liu DH
• Liu SL
• Chen QY
• Guo SS
• Wen YF
• Liu LT
• Xie HJ
• Tang QN
• Liang YJ
• Li XY
• Yan JJ
• Hong MH
• Ma J
• Tang LQ
• Mai HQ

• KMID: 2460594
• DOI: http://doi.org/10.4143/crt.2018.688

Abstract

PURPOSE
The purpose of this study was to investigate the survival trends and patterns of failure in patients with stage II nasopharyngeal carcinoma (NPC) treated with radiotherapy (RT) and chemotherapy over the last 20 years.
MATERIALS AND METHODS
Thirty-eight hundred and eight patients diagnosed with stage II NPC between January 1990 and December 2012 were involved in this retrospective cohort study. All patients were treated with RT. According to the main imaging techniques and RT technology, we categorized these patients into four calendar periods: 1990-1996, 1997-2002, 2003-2007, and 2008-2012. Overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were served as the clinical outcome.
RESULTS
After a median follow-up period of 84.7 months, we observed increasing trends in survival and disease control. The 3- and 5-year OS rates increased from 87.1% and 78.7% in the first calendar period to 97.4% and 94.5% in the last calendar period, respectively (p<0.001). Additionally, significant increasing trends could be seen in the PFS and LRFS during the four calendar periods. In the subgroup analysis, the LRFS in patients older than 50 years at diagnosis showed greater improvement than younger patients. However, the rate of distant metastasis was stable and relatively low, as the 5-year DMFS ranged from 90.5% to 94.7% among the four calendar periods.
CONCLUSION
The survival rates in patients with stage II NPC showed increasing trends from 1990 to 2012. The advance of RT provided excellent locoregional control and enhanced OS.

Keyword

Nasopharyngeal carcinoma; Radiotherapy; Prognosis

MeSH Terms

Cohort Studies*
Diagnosis
Disease-Free Survival
Drug Therapy
Follow-Up Studies
Humans
Neoplasm Metastasis
Prognosis
Radiotherapy
Retrospective Studies*
Survival Rate

Figure

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  Fig. 1. Kaplan-Meier survival curves for the four calendar periods in the study population. Overall survival (OS) (A), progression-free survival (PFS) (B), locoregional relapse-free survival (LRFS) (C), and distant metastasis-free survival (DMFS) (D) compared across the entire cohort of stage II nasopharyngeal carcinoma patients. p-values were calculated using the unadjusted log-rank test.

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  Fig. 2. The 5-year survival rates for the four age subgroups in the four calendar periods. The 5-year overall survival (OS) rate (A), progression-free survival (PFS) rate (B), locoregional relapse-free survival (LRFS) rate (C), and distant metastasis-free survival (DMFS) rate (D) are shown in different age subgroups in the 1990-1996, 1997-2002, 2003-2007, and 2008-2012 periods.

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  Fig. 3. Kaplan-Meier survival curves for the four radiotherapy techniques in the study population. Overall survival (OS) (A), progression-free survival (PFS) (B), locoregional relapse-free survival (LRFS) (C), and distant metastasis-free survival (DMFS) (D) compared across the entire cohort of stage II nasopharyngeal carcinoma patients. p-values were calculated using the unadjusted log-rank test. 2DCRT, two-dimensional conventional radiotherapy; CT-SIM, computed tomography simulator; 3DRT, three-dimensional conformal radiotherapy; IMRT, intensity-modulated radiotherapy.

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  Fig. 4. Kaplan-Meier survival curves for the four radiotherapy techniques in our study. Overall survival (OS) (A), progression-free survival (PFS) (B), locoregional relapse-free survival (LRFS) (C), and distant metastasis-free survival (DMFS) (D) compared across the stage II nasopharyngeal carcinoma patients from 2003-2012. p-values were calculated using the unadjusted log-rank test. 2DCRT, two-dimensional conventional radiotherapy; CT-SIM, computed tomography simulator; 3DRT, three-dimensional conformal radiotherapy; IMRT, intensity-modulated radiotherapy.

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  Fig. 5. Kaplan-Meier survival curves for the different treatment methods in our study. Overall survival (OS) (A), progression-free survival (PFS) (B), locoregional relapse-free survival (LRFS) (C), and distant metastasis-free survival (DMFS) (D) compared across the entire cohort of stage II nasopharyngeal carcinoma patients. p-values were calculated using the unadjusted log-rank test. RT, radiotherapy; CT, computed tomography.

Reference

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