Clinical features and survival outcomes between ascending and descending types of nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: A big-data intelligence platform-based analysis

Ji-Jin Yao; Zhen-Yu Qi; Zhi-Gang Liu; Guan-Min Jiang; Xi-Wei Xu; Shao-Yi Chen; Feng-Ting Zhu; Wang-Jian Zhang; Wayne R Lawrence; Jun Ma; Guan-Qun Zhou; Ying Sun

doi:10.1016/j.radonc.2019.04.025

Clinical features and survival outcomes between ascending and descending types of nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: A big-data intelligence platform-based analysis

Radiother Oncol. 2019 Aug:137:137-144. doi: 10.1016/j.radonc.2019.04.025. Epub 2019 May 15.

Authors

Ji-Jin Yao¹, Zhen-Yu Qi², Zhi-Gang Liu³, Guan-Min Jiang⁴, Xi-Wei Xu³, Shao-Yi Chen³, Feng-Ting Zhu⁵, Wang-Jian Zhang⁶, Wayne R Lawrence⁶, Jun Ma², Guan-Qun Zhou⁷, Ying Sun⁸

Affiliations

¹ Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, PR China; Department of Head and Neck Oncology, The Cancer Center of The Fifth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Biomedical Imaging, Zhuhai, PR China.
² Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, PR China.
³ Department of Head and Neck Oncology, The Cancer Center of The Fifth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Biomedical Imaging, Zhuhai, PR China.
⁴ Department of Clinical Laboratory, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, PR China.
⁵ Department of Imaging Diagnosis and Interventional Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yatsen University Cancer Center, Guangzhou, PR China.
⁶ Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, United States.
⁷ Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, PR China. Electronic address: [email protected].
⁸ Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, PR China. Electronic address: [email protected].

PMID: 31102988
DOI: 10.1016/j.radonc.2019.04.025

Abstract

Purpose: To compare clinical features and survival outcomes in patients with ascending type (type A) and descending type (type D) nasopharyngeal carcinoma (NPC) in the intensity-modulated radiotherapy (IMRT) era.

Materials and methods: A total of 5194 patients with type A and type D NPC treated at Sun Yat-sen University Cancer Center were randomly selected. Tumors that were mainly advanced local disease (T3-4 stage) with early stage cervical lymph node involvement (N0-1 stage) were determined as type A, while tumors with advanced lymph node disease (N2-3 stage) but early stage local invasion (T1-2 stage) were classified as type D NPC. Kaplan-Meier's analysis was used to evaluate survival rates, and log-rank test survival curves were used for comparison. In the multivariate analysis Cox proportional hazard models were developed.

Results: There was a larger proportion of type A tumors (82%) than type D tumors (18%). Compared to patients with type A tumors, those with type D tumors had increased likelihood of distant metastasis, regional recurrence, disease recurrence, and death (P < 0.001 for all), however, not for local recurrence (P < 0.001). The HR (hazard ratio) for death following recurrence of disease for type D tumors were 1.6 compared to type A tumors. Multivariate analysis revealed that elevated EBV DNA, elevated lactate dehydrogenase, alcohol consumption, and no family history of cancer attributed to the development of type D tumors. Annual hazard rate in type A patients increased, peaking at 12-18 months after initial treatment and downward thereafter. Similar trend also occurred in type D during the first 5 years following treatment. Notably, a minor peak was also observed 7-8 years post treatment.

Conclusions: In the IMRT era, recurrence patterns differed across tumor types. Type D NPC had a more aggressive clinical course and worse outcomes compared with type A NPC.

Keywords: Ascending type; Clinical features; Descending type; Intensity-modulated radiotherapy; Nasopharyngeal carcinoma; Survival outcomes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Big Data
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Nasopharyngeal Carcinoma / pathology
Nasopharyngeal Carcinoma / radiotherapy*
Nasopharyngeal Neoplasms / pathology
Nasopharyngeal Neoplasms / radiotherapy*
Neoplasm Recurrence, Local / pathology
Neoplasm Staging
Proportional Hazards Models
Radiotherapy, Intensity-Modulated
Retrospective Studies
Survival Rate