Skip to main content

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

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusions

Histology is an independent prognostic factor in patients with NPC. However, advanced nodal stage is not associated with lower survival in KSCC.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. https://doi.org/10.3322/caac.21492.

    Article  PubMed  Google Scholar 

  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 

  3. Yu WM, Hussain SS. Incidence of nasopharyngeal carcinoma in Chinese immigrants, compared with Chinese in China and South East Asia: review. J Laryngol Otol. 2009;123(10):1067–74. https://doi.org/10.1017/S0022215109005623.

    Article  CAS  PubMed  Google Scholar 

  4. Roy Chattopadhyay N, Das P, Chatterjee K, et al. Higher incidence of nasopharyngeal carcinoma in some regions in the world confers for interplay between genetic factors and external stimuli. Drug Discov Ther. 2017;11(4):170–80. https://doi.org/10.5582/ddt.2017.01030.

    Article  CAS  PubMed  Google Scholar 

  5. Ou SH, Zell JA, Ziogas A, Anton-Culver H. Epidemiology of nasopharyngeal carcinoma in the United States: improved survival of Chinese patients within the keratinizing squamous cell carcinoma histology. Ann Oncol. 2007;18(1):29–35. https://doi.org/10.1093/annonc/mdl320.

    Article  PubMed  Google Scholar 

  6. Ruuskanen M, Grenman R, Leivo I, et al. Outcome of nasopharyngeal carcinoma in Finland: a nationwide study. Acta Oncol. 2018;57(2):251–6. https://doi.org/10.1080/0284186X.2017.1346378.

    Article  PubMed  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.

    Article  PubMed  Google Scholar 

  8. Tang LL, Chen YP, Mao YP, et al. Validation of the 8th edition of the UICC/AJCC staging system for nasopharyngeal carcinoma from endemic areas in the intensity-modulated radiotherapy era. J Natl Compr Cancer Netw. 2017;15(7):913–9. https://doi.org/10.6004/jnccn.2017.0121.

    Article  Google Scholar 

  9. Pan JJ, Ng WT, Zong JF, et al. Proposal for the 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy. Cancer. 2016;122(4):546–58. https://doi.org/10.1002/cncr.29795.

    Article  PubMed  Google Scholar 

  10. Lee AW, Sze WM, Au JS, et al. Treatment results for nasopharyngeal carcinoma in the modern era: the Hong Kong experience. Int J Radiat Oncol Biol Phys. 2005;61(4):1107–16. https://doi.org/10.1016/j.ijrobp.2004.07.702.

    Article  PubMed  Google Scholar 

  11. Vazquez A, Khan MN, Govindaraj S, et al. Nasopharyngeal squamous cell carcinoma: a comparative analysis of keratinizing and nonkeratinizing subtypes. Int Forum Allergy Rhinol. 2014;4(8):675–83. https://doi.org/10.1002/alr.21332.

    Article  PubMed  Google Scholar 

  12. Huang XD, Zhou GQ, Lv JW, et al. Competing risk nomograms for nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: a big-data, intelligence platform-based analysis. Radiother Oncol. 2018;129(2):389–95. https://doi.org/10.1016/j.radonc.2018.09.004.

    Article  PubMed  Google 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.

    Article  CAS  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  Google Scholar 

  17. Reddy SP, Raslan WF, Gooneratne S, et al. Prognostic significance of keratinization in nasopharyngeal carcinoma. Am J Otolaryngol. 1995;16(2):103–8. https://doi.org/10.1016/0196-0709(95)90040-3.

    Article  CAS  PubMed  Google 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.

  19. Hamilton SN, Ho C, Laskin J, et al. Asian versus non-Asian outcomes in nasopharyngeal carcinoma: a North American population-based analysis. Am J Clin Oncol. 2016;39(6):575–80. https://doi.org/10.1097/COC.0000000000000091.

    Article  PubMed  Google Scholar 

  20. Levine PH, Connelly RR, Easton JM. Demographic patterns for nasopharyngeal carcinoma in the United States. Int J Cancer. 1980;26(6):741–8. https://doi.org/10.1002/ijc.2910260607.

    Article  CAS  PubMed  Google Scholar 

  21. Burt RD, Vaughan TL, McKnight B. Descriptive epidemiology and survival analysis of nasopharyngeal carcinoma in the United States. Int J Cancer. 1992;52(4):549–56. https://doi.org/10.1002/ijc.2910520409.

    Article  CAS  PubMed  Google Scholar 

  22. García-Lorenzo J, Farre N, Codina A, et al. Nasopharyngeal carcinoma: 30-year experience of a single institution in a non-endemic area. Clin Transl Oncol. 2017;19(6):777–83. https://doi.org/10.1007/s12094-016-1606-x.

    Article  PubMed  Google Scholar 

  23. Petersson F. Nasopharyngeal carcinoma: a review. Semin Diagn Pathol. 2015;32(1):54–73. https://doi.org/10.1053/j.semdp.2015.02.021.

    Article  PubMed  Google Scholar 

  24. Shi W, Pataki I, MacMillan C, et al. Molecular pathology parameters in human nasopharyngeal carcinoma. Cancer. 2002;94(7):1997–2006. https://doi.org/10.1002/cncr.0679.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  26. Skinner DW, Van Hasselt CA, Tsao SY. Nasopharyngeal carcinoma: modes of presentation. Ann Otol Rhinol Laryngol. 1991;100(7):544–51. https://doi.org/10.1177/000348949110000705.

    Article  CAS  PubMed  Google 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Lee VH, Lam KO, Chang AT, et al. Management of nasopharyngeal carcinoma: is adjuvant therapy needed? J Oncol Pract. 2018;14(10):594–602. https://doi.org/10.1200/JOP.18.00219.

    Article  PubMed  Google Scholar 

  30. Ji X, Zhang W, Xie C, et al. Nasopharyngeal carcinoma risk by histologic type in central China: impact of smoking, alcohol and family history. Int J Cancer. 2011;129(3):724–32. https://doi.org/10.1002/ijc.25696.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Funding

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.

Authorship

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.

Disclosures

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.

Author information

Authors and Affiliations

Authors

Corresponding authors

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

Additional information

Enhanced Digital Features

To view enhanced digital features for this article go to https://doi.org/10.6084/m9.figshare.9864269.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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). https://doi.org/10.1007/s12325-019-01100-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-019-01100-7

Keywords

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