Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Orange, California, USA.
Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2021 Jul;165(1):93-103. doi: 10.1177/0194599820973241. Epub 2020 Nov 24.
To comprehensively investigate nasopharyngeal carcinoma (NPC) treatment, overall survival (OS), and the influence of clinical/sociodemographic factors on outcome.
Retrospective database study.
National Cancer Database.
The 2004-2015 National Cancer Database was queried for all patients with NPC receiving definitive treatment. Log-rank tests and Cox proportional hazards models were used for statistical analyses.
A total of 8260 patients with NPC were included (71.4% male; 42.5% with keratinizing histology; mean ± SD age, 52.1 ± 15.1 years), with a 5-year OS of 63.4%. Multivariate predictors of mortality included age ≥65 years (hazard ratio [HR], 1.81; < .001), Charlson/Deyo score ≥1 (HR, 1.27; = .001), American Joint Committee on Cancer clinical stage III to IV (HR, 1.85; < .001), and government insurance or no insurance (HR, 1.53; < .001). Predictors of survival included female sex (HR, 0.82; = .002), Asian/Pacific Islander race (HR, 0.74; < .001), nonkeratinizing/undifferentiated histology (HR, 0.79; = .004), and receiving treatment at academic centers (HR, 0.87; = .02). Chemoradiotherapy (CRT) demonstrated improved OS as compared with radiotherapy (RT) only for stage II ( = .006) and stage III ( = .005) and with RT or chemotherapy only in stage IVA NPC ( < .001). When compared with CRT alone, surgery plus CRT provided OS benefits in keratinizing ( = .013) or stage IVA ( = .030) NPC. When compared with RT, CRT provided OS benefits in keratinizing ( = .005) but not nonkeratinizing ( = .240) or undifferentiated ( = .390) NPC. Substandard radiation dosing of <60 Gy and <30 fractions were associated with inferior OS (both < .001).
NPC survival is dependent on a variety of clinical/sociodemographic factors. Stage-specific treatments with optimal OS include CRT or RT for stages I to II and CRT for stage III to IV. The large representation of nonendemic histology is valuable, as these cases are not well characterized.
全面调查鼻咽癌（NPC）的治疗方法、总生存率（OS），以及临床/社会人口统计学因素对预后的影响。
回顾性数据库研究。
国家癌症数据库。
从 2004 年至 2015 年，国家癌症数据库被用来查询所有接受确定性治疗的 NPC 患者。采用对数秩检验和 Cox 比例风险模型进行统计学分析。
共纳入 8260 例 NPC 患者（71.4%为男性；42.5%为角化组织学；平均年龄±标准差为 52.1±15.1 岁），5 年 OS 为 63.4%。死亡率的多变量预测因素包括年龄≥65 岁（风险比[HR]，1.81；<.001）、Charlson/Deyo 评分≥1（HR，1.27；<.001）、美国癌症联合委员会临床分期 III 至 IV 期（HR，1.85；<.001）和政府保险或无保险（HR，1.53；<.001）。生存的预测因素包括女性（HR，0.82；=.002）、亚裔/太平洋岛民（HR，0.74；<.001）、非角化/未分化组织学（HR，0.79；=.004）和在学术中心接受治疗（HR，0.87；=.02）。与单纯放疗（RT）相比，放化疗（CRT）在 II 期（=.006）和 III 期（=.005）以及 IVA 期 NPC（<.001）中改善了 OS。与单纯 CRT 相比，手术加 CRT 为角化 NPC（=.013）或 IVA 期 NPC（=.030）提供了 OS 获益。与 RT 相比，CRT 为角化 NPC（=.005）但非非角化（=.240）或未分化（=.390）NPC 提供了 OS 获益。剂量低于 60 Gy 和 30 个分割的标准放疗与较差的 OS 相关（均<.001）。
NPC 的生存取决于多种临床/社会人口统计学因素。具有最佳 OS 的特定于阶段的治疗方法包括 I 期至 II 期的 CRT 或 RT，以及 III 期至 IV 期的 CRT。大量的非地方性组织学表现具有重要价值，因为这些病例的特征还不清楚。
