Abstract：Objective To evaluate the survival prognosis for T1 stage nasopharyngeal carcinoma patients complicated with different stages of cervical lymph node metastasis, aiming to provide reference for optimizing the treatment plan. Methods Clinical data of 413 patients in non-keratinizing carcinoma and undifferentiated locally early nasopharyngeal carcinoma (T1N0-3M0-1) undergoing radiotherapy alone or radiochemotherapy in Department of Radiation Oncology of our hospital from January 2014 to December 2019 were retrospectively analyzed. The survival analyses were performed with Kaplan-Meier method and statistically compared using the log-rank test. Results Of all patients, 291 were male, and 122 were female (aged from 9 to 78 years old) with a median age of 51 years old. All patients were diagnosed with T1N0-3M0-1 nasopharyngeal carcinoma. In the TNM stage grouping system, 48(11.6%) patients were classified as stage Ⅰ (T1N0M0), 158(38.2%) cases of stage Ⅱ(T1N1M0), 162(39.2%) cases of stage Ⅲ(T1N2M0), and 45(10.9%) cases of stage ⅣA to ⅣB(T1N3M0/T1NxM1). Eight patients (1.9%) with stage ⅣB had metastasis at presentation. The lymph node positivity rate of all patients reached up to 88.1%. Seven patients received three-dimensional conformal radiotherapy, 371 cases of intensity-modulated radiotherapy and 35 cases of volumetric-modulated arc therapy. The 5-year overall survival rate was (95.9±1.2)% and with 100% for T1N0M0 patients,(99.2±0.8)% for T1N1M0 patients,(95.1±2.2)% for T1N2M0 patients and (87.9±6.6)% for T1N3M0 patients, respectively. Primary distant metastasis and N3 stage were significantly correlated with poor prognosis (both P<0.05). The most common long-term side effect of radiotherapy was xerostomia with an incidence rate of 18.6%(17.9% for grade 1 toxicity), followed by hearing damage and tooth discomfort. Only 2 patients developed Grade Ⅲ toxic reactions, manifested as complete hearing loss. Conclusions Although T1 nasopharyngeal carcinoma patients have a high propensity of cervical node metastasis, favorable clinical prognosis can be obtained after radiotherapy alone. Moreover, the long-term side effects under precision radiation exert no severe effect upon the quality of life of patients.
Yan Li,Wang Shengzi,Zhu Yi et al. Prognosis analysis of T1 stage nasopharyngeal cancer with different lymph node and metastasis stages in the era of precision radiotherapy[J]. Chinese Journal of Radiation Oncology, 2021, 30(8): 764-769.
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