Lymph Node Status and Outcomes for Nasopharyngeal Carcinoma According to Histological Subtypes: A SEER Population-Based Retrospective Analysis
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We aimed to investigate the clinical effect of histological subtypes on survival in nasopharyngeal carcinoma (NPC), and assess the effect of nodal stage on outcome according to histological subtypes.
Patients with non-metastatic NPC were identified from the Surveillance, Epidemiology and End-Results (SEER) database between 2004 and 2014. Statistical analysis was performed using the chi-squared test, Kaplan–Meier methods, and multivariate Cox regression models.
We identified 2845 patients in this study including 1218 (42.8%), 849 (29.8%), and 778 (27.3%) patients with keratinizing squamous cell carcinoma (KSCC), differentiated non-keratinizing squamous cell carcinoma (DNKSCC), and undifferentiated non-keratinizing squamous cell carcinoma (UNKSCC), respectively. The multivariate analysis indicated that patients with UNKSCC subtype had better NPC-specific survival (NPC-SS) (P < 0.001) compared to KSCC (P < 0.001) and DNKSCC (P < 0.001) patients. The 5-year NPC-SS was 75.2%, 77.9%, and 88.9% in patients with KSCC, DNKSCC, UNKSCC, respectively (P < 0.001). Subgroup analysis showed that advanced nodal stage was related to lower NPC-SS in patients with DNKSCC and UNKSCC but not in patients with KSCC.
Histology is an independent prognostic factor in patients with NPC. However, advanced nodal stage is not associated with lower survival in KSCC.
KeywordsKeratinizing Lymph node Nasopharyngeal carcinoma Non-keratinizing Undifferentiated
This work was partly supported by the National Natural Science Foundation of China (no. 81570818). The sponsor also partially funded the journal’s Rapid Service fee.
This paper was proofread by a native English professional with science background at Elixigen Corporation.
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
Rui Guo, Han Wu, Jun Wang, Chen-Lu Lian, Zhen-Yu He, Wen-Wen Zhang, Yong-Xiong Chen, and San-Gang Wu have nothing to disclose.
Compliance with Ethics Guidelines
All SEER data were accessed with approval from the SEER database and, as such, this article does not contain any studies with human participants or animals performed by any of the authors.
The datasets analyzed during the current study are available from the corresponding author on reasonable request.
- 2.Chan JKC, Bray F, McCarron P, et al. Nasopharyngeal carcinoma. In: Barnes EL, Eveson JW, Reichart P, Sdransky D, editors. Pathology and genetics of head and neck tumours. World Health Organization Classification of Tumours. Lyon: IARC; 2005. p. 85–97.Google Scholar
- 7.Arnold M, Wildeman MA, Visser O, et al. Lower mortality from nasopharyngeal cancer in the Netherlands since 1970 with differential incidence trends in histopathology. Oral Oncol. 2013;49(3):237–43. https://doi.org/10.1016/j.oraloncology.2012.09.016.CrossRefPubMedGoogle Scholar
- 13.Lee HW, Hwang YH, Han JH, et al. High expression of excision repair cross-complementation group 1 protein predicts poor outcome in patients with nasopharyngeal cancer. Oral Oncol. 2010;46(3):209–13. https://doi.org/10.1016/j.oraloncology.2009.12.007.CrossRefPubMedGoogle Scholar
- 14.Cheung F, Chan O, Ng WT, et al. The prognostic value of histological typing in nasopharyngeal carcinoma. Oral Oncol. 2012;48(5):429–33. https://doi.org/10.1016/j.oraloncology.2011.11.017.CrossRefPubMedGoogle Scholar
- 15.Xu C, Chen YP, Liu X, et al. Establishing and applying nomograms based on the 8th edition of the UICC/AJCC staging system to select patients with nasopharyngeal carcinoma who benefit from induction chemotherapy plus concurrent chemoradiotherapy. Oral Oncol. 2017;69:99–107. https://doi.org/10.1016/j.oraloncology.2017.04.015.CrossRefPubMedGoogle Scholar
- 16.OuYang PY, You KY, Zhang LN, et al. External validity of a prognostic nomogram for locoregionally advanced nasopharyngeal carcinoma based on the 8th edition of the AJCC/UICC staging system: a retrospective cohort study. Cancer Commun (Lond). 2018;38(1):55. https://doi.org/10.1186/s40880-018-0324-x.CrossRefGoogle Scholar
- 18.Surveillance, Epidemiology, and End Results (SEER) Program (http://www.seer.cancer.gov) SEER*Stat Database: Incidence—SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2016 Sub (1973–2014 varying)—Linked To County Attributes—Total U.S., 1969–2015 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2017, based on the November 2016 submission.
- 25.Shanmugaratnam K, Sobin LH. The World Health Organization histological classification of tumours of the upper respiratory tract and ear. A commentary on the second edition. Cancer. 1993;71(8):2689–97. https://doi.org/10.1002/1097-0142(19930415)71:8%3c2689:aid-cncr2820710843%3e3.0.co;2-h.CrossRefPubMedGoogle Scholar
- 27.Amin MB, Edge S, Greene F, et al., editors. AJCC cancer staging manual. 8th ed. New York: Springer; 2016.Google Scholar
- 28.Yang XL, Wang Y, Liang SB, et al. Comparison of the seventh and eighth editions of the UICC/AJCC staging system for nasopharyngeal carcinoma: analysis of 1317 patients treated with intensity-modulated radiotherapy at two centers. BMC Cancer. 2018;18(1):606. https://doi.org/10.1186/s12885-018-4419-1.CrossRefPubMedPubMedCentralGoogle Scholar