Role of combined surgical and radiotherapy treatment in nonmetastatic WHO I nasopharyngeal carcinoma patients

Abstract

Background

Keratinizing squamous cell carcinoma (KSCC) is recognized as WHO I nasopharyngeal carcinoma (NPC). Current guidelines for treating nasopharyngeal cancer do not delineate specific strategies for individual pathologic subtypes.

Objectives

To explore the optimal treatment for KSCC of the nasopharynx.

Material and methods

Data on patients were extracted from the SEER database. Survival differences between patients treated with radiotherapy alone and combined surgery were assessed using Kaplan-Meier and Cox regression models and compared using propensity score matching (PSM). In addition, we explored the survival differences between the two groups of patients in different risk stratifications.

Results

In our study, 165 patients underwent surgical intervention, while 1238 patients did not. In both univariate (CSS: p = .001, HR = 0.612; OS: p < .001, HR = 0.623) and multivariate (CSS: p = .004, HR = 0.655; OS: p < .001, HR = 0.655) analyses, combined surgery was identified as a significant prognostic factor. These findings were consistent after PSM. Using RPA, patients were categorized into two groups. CSS improved in the high-risk group, whereas the difference in low-risk patients was not significant.

Conclusions and significance

For patients diagnosed with WHO I nasopharyngeal carcinoma, the combination of radiotherapy and surgery has significant clinical advantages, especially for patients at high risk.

Chinese abstract

背景

角质化鳞状细胞癌 (KSCC) 被认定为 世卫组织I型(WHO I )鼻咽癌 (NPC)。目前治疗鼻咽癌的指南并未提供针对各个病理亚型的具体方法。

目的

探索鼻咽 KSCC 的最佳治疗方法。

材料和方法

从 SEER 数据库中提取患者数据。使用 Kaplan-Meier 和 Cox 回归模型评估仅接受放射治疗和联合手术治疗的患者的生存差异, 并使用倾向评分匹配 (PSM) 进行比较。此外, 我们探讨了不同风险水平的两组患者的生存差异。

结果

在我们的研究中, 165 名患者接受了手术干预, 而 1238 名患者未接受手术干预。在单变量(CSS: p=.001, HR = 0.612；OS: p<.001, HR = 0.623)和多变量(CSS: p=.004, HR = 0.655；OS: p<.001, HR = 0.655)分析中, 联合手术被确定为重要的预后因素。在 PSM之后这些发现仍保持一致。使用 RPA, 患者被分为两组。高风险组的 CSS 有所改善, 而低风险患者的差异并不显著。

结论和意义

对于诊断为 WHO I 鼻咽癌的患者, 放疗和手术的结合具有显著的临床优势, 对于高风险患者尤为如此。

Keywords:

• Head and neck cancer
• WHO I nasopharyngeal cancer
• radiotherapy
• surgery

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Program of Sun Yat-Sen University for Clinical Research 5010 Program [No. 2018015]. Startup Funds for Staff Trained Overseas of Sun Yat-sen University Cancer Center (H1625).