Department of Radiation Oncology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China.
Department of Radiology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Front Public Health. 2022 Jul 7;10:912843. doi: 10.3389/fpubh.2022.912843. eCollection 2022.
To assess the causes of death (COD) and long-term survival after nasopharyngeal carcinoma (NPC) diagnosis.
Using linked data from the Surveillance, Epidemiology, and End Results program, patients with NPC diagnosed from 1990 to 2010 and followed up >5 years were identified. Chi-squared test, the Kaplan-Meier method, and the Cox proportional hazard model were used for analyses.
Among the 3,036 long-term NPC survivors, 1,432 survived for >5-10 years and 1,604 survived for >10 years. The most common COD was primary NPC (36.9%), followed by other causes (28.7%), other cancers (15.3%), cardiac disease (12.9%), and non-malignant pulmonary disease (6.2%). With a median follow-up of 125 months, deaths from NPC decreased with increasing time from diagnosis, while death because of cardiac disease and other causes increased. In those aged <50 years, death due to NPC remained the main COD over time, while cardiopulmonary disease-related death was the leading COD in patients aged ≥50 years. In White patients, death due to NPC decreased, and death due to cardiac disease increased over time. Death from NPC remained significant in Black and Asian patients even 15 years after the diagnosis of NPC, while death due to cardiac disease significantly increased after 9 years of diagnosis in Black patients. Multivariate analyses showed that the independent factors associated with inferior NPC-specific survival were older age, Asians, American Indian/Alaska Native, regional stage, distant stage, and diagnosis in the early years.
The probability of death from primary NPC remains significant even 15 years after the NPC diagnosis. Our study advocates continued surveillance for NPC survivors beyond the traditional 5 years. Individualized follow-up strategies are required for patients with NPC of different ages and races.
评估鼻咽癌（NPC）诊断后的死因（COD）和长期生存情况。
利用监测、流行病学和最终结果（SEER）计划的相关数据，确定了 1990 年至 2010 年间诊断为 NPC 并随访时间超过 5 年的患者。采用卡方检验、Kaplan-Meier 法和 Cox 比例风险模型进行分析。
在 3036 名长期 NPC 幸存者中，1432 名幸存者存活时间超过 5-10 年，1604 名幸存者存活时间超过 10 年。最常见的 COD 是原发性 NPC（36.9%），其次是其他原因（28.7%）、其他癌症（15.3%）、心脏病（12.9%）和非恶性肺部疾病（6.2%）。中位随访时间为 125 个月，NPC 相关死亡随着诊断后时间的延长而减少，而心脏病和其他原因导致的死亡则增加。在年龄<50 岁的患者中，随着时间的推移，NPC 相关死亡仍然是主要的 COD，而心肺疾病相关死亡是年龄≥50 岁患者的主要 COD。在白人患者中，随着时间的推移，NPC 相关死亡减少，心脏病相关死亡增加。即使在 NPC 诊断后 15 年，黑人和亚洲患者 NPC 相关死亡仍然显著，而黑人患者在 NPC 诊断后 9 年心脏病相关死亡显著增加。多变量分析显示，NPC 特异性生存较差的独立危险因素包括年龄较大、亚洲人、美国印第安人/阿拉斯加原住民、局部分期、远处分期和早期诊断。
即使在 NPC 诊断后 15 年，原发性 NPC 导致死亡的概率仍然显著。我们的研究主张对 NPC 幸存者进行超过传统 5 年的持续监测。需要为不同年龄和种族的 NPC 患者制定个体化的随访策略。
