In a single-center study reported in JAMA Network Open, Alsavaf et al attempted to identify patient characteristics and treatment outcomes of nasopharyngeal carcinoma in the United States, a nonendemic region of the disease.
Study Details
The retrospective cohort study included patients with nasopharyngeal carcinoma treated at The Ohio State University Wexner Medical Center from 2000 to 2023.
The population included 159 adult patients with nasopharyngeal carcinoma (median age = 53.5 years, range = 18–90 years); 117 (73.6%) were male, 23 (15.3%) were African American, 21 (14.0%) were Asian, and 106 (70.7%) were White.
World Health Organization type III tumors were most common, found in 88 patients (68.8%); followed by type II, found in 25 patients (19.5%); and type I, found in 15 patients (11.7%).
Epstein-Barr virus (EBV) positivity status varied widely by race, including 13 Asian patients (81.3%), 17 African American patients (63.0%), and 40 White patients (47.0%; P = .03 for trend); and by WHO type tumors, including 50 type III patients (72.5%), 10 type II patients (48.0%), and no type I patients (0%; P < .001 for trend).
p16-positive status, as a marker for human papillomavirus (HPV)-positive status, did not vary by race; however, significant variation in p16 positivity was found according to histopathology: type III = 12 patients (28.5%); type II = 12 patients (63.0%); and type I = 3 patients (43.0%; P = .04 for trend).
On univariate analysis, factors associated with poorer overall survival included older age at diagnosis, current smoking status, and EBV-negative status. On multivariate analysis, increasing age (hazard ratio [HR] per 1-year increase = 1.03, 95% CI = 1.00–1.05, P = .04) and former smoking status (HR = 2.29, 95% CI = 1.03–5.10, P = .04) were associated with poorer overall survival. WHO type III tumors were associated with better overall survival vs type I tumors (HR = 0.38, 95% CI = 0.17–0.87, P = .02). Male sex was associated with worse progression-free survival (HR = 5.35, 95% CI = 1.23–23.30, P = .03). p16 status was not associated with overall survival or progression-free survival.
Recurrence-free survival was significantly poorer in former smokers (HR = 25.24, 95% CI = 2.56–249.23, P = .006), current smokers (HR = 44.97, 95% CI = 2.27–892.10, P = .01), and patients with advanced stages of disease (IVa/b; HR = 261.34, 95% CI = 3.96–17, 258.06, P = .009).
The investigators concluded: “This cohort study contributes to the evolving body of knowledge on [nasopharyngeal carcinoma] in nonendemic regions, finding a shift toward WHO type III tumors and underscoring the association of EBV status with survival outcomes, while highlighting the lack of association between [HPV] status and outcomes. Smoking history, advanced stage at diagnosis, male sex, and increasing age emerged as adverse factors. Notably, WHO type I tumors demonstrated particularly poor outcomes, highlighting the need for more intensive follow-up in this subgroup.”
Marcelo Bonomi, MD, of The Ohio State University Wexner Medical Center, is the corresponding author for the JAMA Network Open article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
