Factors associated with early diagnosis in pediatric vs adult nasopharyngeal carcinoma

Abstract

Objective: To improve understanding of the initial symptom between pediatric and adult nasopharyngeal carcinoma (NPC) and to improve the early diagnosis of NPC.

Methods: This retrospective cohort study included all 353 patients with a primary diagnosis of NPC in the First Affiliated Hospital of Zhengzhou University from January 2010 to December 2016. Of these, 34 patients were 21 years or younger (pediatric); 319 patients, older than 21 years (adult). Data were analyzed after data collection.

Results: We found no difference between pediatric and adult patients in terms of their sex distribution (p > .05).Type III, undifferentiated carcinoma is the most common subtype in Pediatric patients, while adult patients had more squamous cell tumors (p < .01). Pediatric patients were more likely to present with stage IV disease (p <  .05). Of the 353 patients, 120 (34.0%) had only one presenting symptom initially; however, most patients presented two or more episodes. Neck mass was the most common presenting symptom initially in children and adolescents, while multiple ear symptoms in adult patients (p = .003). The median time from onset of the presenting symptom to diagnosis is three months, adult patient presented longer history (64.7% vs 44.55, p < .05). Of the 319 adult patients, there were 142 which the time from onset of the presenting symptom to diagnosis is less than 3 months and there were 177 more than 3 months, the difference was significant between the two groups (p < .05). There were no differences in the misdiagnosis rate between pediatric and adult (35.1 vs 31.0, p > .05). Among pediatric patients, 31 (91.2%) had positive EBV DNA in peripheral plasma. EBV DNA was significantly associated with stage (p < .05).

Conclusions: Although uncommon, pediatric NPC appears to affect a different patient demographic relative to adult NPC. NPC in children is associated with undifferentiated carcinoma and more advanced disease presentation.

Chinese abstract

目的：提高儿科和成人鼻咽癌初步症状的认识, 改善鼻咽癌的早期诊断。

方法：该回顾性群组研究包括2010年1月至2016年12月郑州大学第一附属医院所有的353例原发性鼻咽癌患者, 其中34例为21岁以下（儿科）; 319例为21岁以上（成人）。资料收集后对此进行了分析。

结果：我们发现儿科和成人患者的性别分布没有差异（p > 0.05）。III型, 未分化癌是儿科患者中最常见的亚型, 而成年患者患有更多的鳞状细胞肿瘤（p < 0. 01）。儿科患者更可能出现IV期癌症（p <.05）。 353例患者中, 120例（34.0%）起初只有一次症状出现；然而, 大多数患者有两次或多次发作。颈部肿块是儿童和青少年最常见的初始症状, 而成年患者的初始症状是耳朵多发症状（p = .003）。从出现症状到诊断的中位时间为3个月, 成年患者具有较长的病史（64.7%相对于 44.55, p < 0.05）。在319名成年患者中, 有142例从出现症状到诊断时长少于3个月, 177例3个月以上, 两组间差异有统计学意义（p < 0.05）。儿科与成人误诊率无差异（35.1%相对于 31.0, p > 0.05）。在儿科患者中, 31例（91.2%）在外周血浆中具有阳性EBV 染色体。 EBV 染色体与疾病阶段显著相关（p < 0.05）。

结论：虽然罕见, 儿科鼻咽癌似乎影响与成人患者不同的人口组成。儿童NPC与未分化癌和晚期疾病相关。

Keywords:

• Nasopharyngeal carcinoma
• initial symptom
• EBV DNA

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.