J Cancer 2018; 9(7):1308-1317. doi:10.7150/jca.21009 This issue

Research Paper

Patterns of Failure and Survival Trends Of 720 Patients with Stage I Nasopharyngeal Carcinoma Diagnosed from 1990-2012: A Large-scale Retrospective Cohort Study

Lin-Quan Tang1,2*, Tong-Yu Lu3*, Yang Li1,2*, Shao-Yan Guo3, Qi-Yu Zhong3, Meng-Sha Zou3, Bo-Lin Chen3, Qing-Nan Tang1,2, Wen-Hui Chen1, Shan-Shan Guo1,2, Li-Ting Liu1,2, Qiu-Yan Chen1,2, Ling Guo1,2, Hao-Yuan Mo1,2, Rui Sun1,2, Dong-Hua Luo1,2, Chong Zhao1,2, Chao-Nan Qian1,2, Xiang Guo1,2, Mu-Sheng Zeng1, Hai-Qiang Mai1,2✉

1. Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine
2. Department of Nasopharyngeal Carcinoma
3. ZhongShan School of Medicine, Sun Yat-sen University
*these authors contributed equally to this work.

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) license (https://creativecommons.org/licenses/by-nc/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Tang LQ, Lu TY, Li Y, Guo SY, Zhong QY, Zou MS, Chen BL, Tang QN, Chen WH, Guo SS, Liu LT, Chen QY, Guo L, Mo HY, Sun R, Luo DH, Zhao C, Qian CN, Guo X, Zeng MS, Mai HQ. Patterns of Failure and Survival Trends Of 720 Patients with Stage I Nasopharyngeal Carcinoma Diagnosed from 1990-2012: A Large-scale Retrospective Cohort Study. J Cancer 2018; 9(7):1308-1317. doi:10.7150/jca.21009. Available from https://www.jcancer.org/v09p1308.htm

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Objectives: To evaluate the patterns of failure and survival trends of patients with stage I nasopharyngeal carcinoma (NPC) treated with radiotherapy alone over the last 20 years.

Materials and Methods: A retrospective cohort study was conducted on 720 patients with stage I NPC who were treated with curative two-dimensional radiotherapy (2DRT), three-dimensional conformal radiotherapy (3DRT), or intensity-modulated radiotherapy (IMRT) between January 1990 and December 2012. The patients were categorized into four calendar periods (1990-1996, 1997-2002, 2003-2007, and 2008-2012) and four age subgroups (18-39, 40-49, 50-59, and >60). We computed overall survival (OS), progression free survival (PFS), locoregional relapse free survival (LRFS) and distant metastasis free survival (DMFS) as measures of patient survival.

Results: After a median follow-up period of 105 months (range 1-280 months), we observed the increasing trends in survival and disease control. The 3-, 5-, and 7-year OS rates increased from 97.0%, 86.7%, and 81.7% in the first calendar period (1990-1996) to 100%, 99.3%, and 98.0% in the last calendar period (2008-2012), respectively (P<0.001). Additionally, significant increasing trends could be seen in the PFS and LRFS during the four calendar periods. In the subgroup analysis, the OS, PFS and LRFS in patients diagnosed older than 40 years had greater improvement than the younger patients. However, the rate of distant metastasis was stable and relatively low, as the 5-year distant metastasis rate ranged from 0.2%-2.5% among the four calendar periods.

Conclusion: The survival rates in patients with stage I NPC showed increasing trends from 1990 to 2012. The advances of radiotherapy provided excellent locoregional control and enhanced overall survival, and in particular, the IMRT decreased locoregional relapse.

Keywords: Nasopharyngeal carcinoma, Radiotherapy, Prognosis