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Lymph Node Status and Outcomes for Nasopharyngeal Carcinoma According to Histological Subtypes: A SEER Population-Based Retrospective Analysis



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.

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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.

Editorial Assistance

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.

Data Availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Correspondence to Yong-Xiong Chen or San-Gang Wu.

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Guo, R., Wu, H., Wang, J. et al. Lymph Node Status and Outcomes for Nasopharyngeal Carcinoma According to Histological Subtypes: A SEER Population-Based Retrospective Analysis. Adv Ther 36, 3123–3133 (2019).

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  • Keratinizing
  • Lymph node
  • Nasopharyngeal carcinoma
  • Non-keratinizing
  • Undifferentiated