AbstractObjective 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.
Fund:Shanghai Medical Guidance Science and Technology Support Project (194019311700)
Corresponding Authors:
Wang Shengzi, Email:shengziwang@fudan.edu.cn
Cite this article:
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.
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.
[1] Chen YP, Chan A, Le QT, et al. Nasopharyngeal carcinoma[J]. Lancet, 2019, 394(10192):64-80. DOI:10.1016/S0140-6736(19)30956-0. [2] Xu T, Huang Z, Deng Y, et al. Clinical implications of hepatitis B viral infection in Epstein-Barr virus-associated nasopharyngeal carcinoma[J]. J Clin Virol, 2015, 64:64-71. DOI:10.1016/j.jcv.2014.11.024. [3] Li S, Hang L, Ma Y, et al. Distinctive microRNA expression in early stage nasopharyngeal carcinoma patients[J]. J Cell Mol Med, 2016, 20(12):2259-2268. DOI:10.1111/jcmm.12906. [4] Lee VH, Lam KO, Chang AT, et al. Management of nasopharyngeal carcinoma:is adjuvant therapy needed?[J]. J Oncol Pract, 2018, 14(10):594-602. DOI:10.1200/JOP.18.00219. [5] Blanchard P, Lee A, Marguet S, et al. Chemotherapy and radiotherapy in nasopharyngeal carcinoma:an update of the MAC-NPC meta-analysis[J]. Lancet Oncol, 2015, 16(6):645-655. DOI:10.1016/S1470-2045(15)70126-9. [6] Bian X, Song T, Wu S. Outcomes of xerostomia-related quality of life for nasopharyngeal carcinoma treated by IMRT:based on the EORTC QLQ-C30 and H&N35 questionnaires[J]. Expert Rev Anticancer Ther, 2015, 15(1):109-119. DOI:10.1586/14737140.2015.961427. [7] Wu C, Guo E, Ming J, et al. Radiation-induced DNMT3B promotes radioresistance in nasopharyngeal carcinoma through methylation of p53 and p21[J]. Mol Ther Oncolytics, 2020, 17:306-319. DOI:10.1016/j.omto.2020.04.007. [8] Chua M, Wee J, Hui EP, et al. Nasopharyngeal carcinoma[J]. Lancet, 2016, 387(10022):1012-1024. DOI:10.1016/S0140-6736(15)00055-0. [9] Pathmanathan R, Prasad U, Chandrika G, et al. Undifferentiated, nonkeratinizing, and squamous cell carcinoma of the nasopharynx. variants of Epstein-Barr virus-infected neoplasia[J]. Am J Pathol, 1995, 146(6):1355-1367. [10] Au KH, Ngan R, Ng A, et al. Treatment outcomes of nasopharyngeal carcinoma in modern era after intensity modulated radiotherapy (IMRT) in Hong Kong:A report of 3328 patients (HKNPCSG 1301 study)[J]. Oral Oncol, 2018, 77:16-21. DOI:10.1016/j.oraloncology.2017.12.004. [11] Sun X, Su S, Chen C, et al. Long-term outcomes of intensity-modulated radiotherapy for 868 patients with nasopharyngeal carcinoma:an analysis of survival and treatment toxicities[J]. Radiother Oncol, 2014, 110(3):398-403. DOI:10.1016/j.radonc.2013.10.020. [12] Xu Y, Huang T, Fan L, et al. Patterns and prognostic value of lymph node metastasis on distant metastasis and survival in nasopharyngeal carcinoma:a surveillance, epidemiology, and end results study, 2006-2015[J]. J Oncol, 2019, 2019:4094395. DOI:10.1155/2019/4094395. [13] Sham JS, Choy D, Wei WI. Nasopharyngeal carcinoma:orderly neck node spread[J]. Int J Radiat Oncol Biol Phys, 1990, 19(4):929-933. DOI:10.1016/0360-3016(90)90014-b. [14] Ho FC, Tham IW, Earnest A, et al. Patterns of regional lymph node metastasis of nasopharyngeal carcinoma:a meta-analysis of clinical evidence[J]. BMC Cancer, 2012, 12:98. DOI:10.1186/1471-2407-12-98. [15] Feng Y, Cao C, Hu Q, et al. Prognostic value and staging classification of lymph nodal necrosis in nasopharyngeal carcinoma after intensity-modulated radiotherapy[J]. Cancer Res Treat, 2019, 51(3):1222-1230. DOI:10.4143/crt.2018.595. [16] Xu Y, Chen X, Zhang M, et al. Prognostic effect of parotid area lymph node metastases after preliminary diagnosis of nasopharyngeal carcinoma:a propensity score matching study[J]. Cancer Med, 2017, 6(10):2213-2221. DOI:10.1002/cam4.1154. [17] Xue F, Ou D, Hu C, et al. Local regression and control of T1-2 nasopharyngeal carcinoma treated with intensity-modulated radiotherapy[J]. Cancer Med, 2018, 7(12):6010-6019. DOI:10.1002/cam4.1866. [18] Li LX, Tian G, He J. The standardization of acupuncture treatment for radiation-induced xerostomia:a literature review[J]. Chin J Integr Med, 2016, 22(7):549-554. DOI:10.1007/s11655-015-2145-y. [19] Sommat K, Hussain A, Ong WS, et al. Clinical and dosimetric predictors of physician and patient reported xerostomia following intensity modulated radiotherapy for nasopharyngeal cancer-A prospective cohort analysis[J]. Radiother Oncol, 2019, 138:149-157. DOI:10.1016/j.radonc.2019.05.023. [20] Pan XB, Liu Y, Huang ST, et al. Predictors for improvement of xerostomia in nasopharyngeal carcinoma patients receiving intensity-modulated radiotherapy[J]. Medicine (Baltimore), 2019, 98(36):e17030. DOI:10.1097/MD.0000000000017030. [21] Lee TF, Liou MH, Ting HM, et al. Patient-and therapy-related factors associated with the incidence of xerostomia in nasopharyngeal carcinoma patients receiving parotid-sparing helical tomotherapy[J]. Sci Rep, 2015, 5:13165. DOI:10.1038/srep13165. [22] Zheng Y, Han F, Xiao W, et al. Analysis of late toxicity in nasopharyngeal carcinoma patients treated with intensity modulated radiation therapy[J]. Radiat Oncol, 2015, 10:17. DOI:10.1186/s13014-014-0326-z. [23] Hwang CF, Fang FM, Zhuo MY, et al. Hearing assessment after treatment of nasopharyngeal carcinoma with CRT and IMRT techniques[J]. Biomed Res Int, 2015, 2015:769806. DOI:10.1155/2015/769806. [24] Zhu W, Chen F, Li J, et al. Dosimetric parameters associated with conductive or sensorineural hearing loss 5 years after intensity-modulated radiation therapy in nasopharyngeal carcinoma[J]. Acta Otolaryngol, 2019, 139(3):263-268. DOI:10.1080/000 16489.2019.1566778. [25] McDowell LJ, Rock K, Xu W, et al. Long-term late toxicity, quality of life, and emotional distress in patients with nasopharyngeal carcinoma treated with intensity modulated radiation therapy[J]. Int J Radiat Oncol Biol Phys, 2018, 102(2):340-352. DOI:10.1016/j.ijrobp.2018.05.060. [26] Luo S, Zhao L, Wang J, et al. Clinical outcomes for early-stage nasopharyngeal carcinoma with predominantly WHO Ⅱ histology treated by intensity-modulated radiation therapy with or without chemotherapy in nonendemic region of China[J]. Head Neck, 2014, 36(6):841-847. DOI:10.1002/hed.23386.
2021, Vol. 30 
