Prognosis Analysis Of Patients With M1Stage Nasopharyngeal Carcinoma At Initially Treament

Background：Nasopharyngeal carcinoma (NPC) is most prevalent in South China with thehighest incidence reported among the province of Guangdong, where rates range from30to50per100000. More than95%of nasopharyngeal carcinoma is poorlydifferentiated squamous cell carcinoma, which tends to be more aggressive. Theincidence of distant metastasis is high in NPC．It is the most important cause of deathfor patients with NPC, and its presence is the most important factor in limitingsurvival. The survival of NPC initially presenting with distant metastasis (Ml stage) isworse than that of NPC developing distant metastasis after primary radiotherapy.There is no agreement on the optimal management of patients initially presenting withmetastatic nasopharyngeal carcinoma. There has been seldom reports about theprognostic factors determining survival of the NPC initially presenting with distantmetastasis (Ml stage), and the prognostic factors in these limited study are different.Research purpose:We set out to perform the present retrospective study，aiming to study the prognosticators determining survival subsequent to NPC initially presenting withdistant metastasis (Ml stage)Material and method:A total Of92NPC patients initially presenting with distant metastasis weretreated in Cancer Center of Guangzhou Medical University from Jan．2001toDec．2007．Of these92patients,75were men and17were women，with a median ageof47years old (range，14—71). The most common site of initial metastasis was bone.39patients presented bony metastasis,13patients presented lung metastasis,11patients presented liver metastasis,27patients presented multiple metastatic sites.68patients received radiotherapy of primary nasopharyngeal tumors combinationchemotherapy，24received chemotherapy alone. The total external radiation doses ofnasopharyngeal ranged from60to72Gy (median,66Gy). The dose of necklymphatics ranged50-60Gy (median56Gy), A total of92patients received371courses of chemotherapy. The regimen of chemotherapy consisted of cisplatin-baseddrugs. All patients received1-12cycles.46of them received over4cycles ofchemotherapy, other46of them received less than4cycles of chemotherapy. Thesurvival rate was calculated by Kaplan-Meier method and compared by log-rank test.Multivariable analysis was performed using the Cox model (p≤0.05was used asthe cut-off value of statistical significance). Factors that were considered included:age group(≤45years or>45years), gender, T stage, N stage, number of metastaticsites (single or multiple), specific metastatic sites(bone, liver, lung), radiotherapy ofprimary nasopharyngeal tumors, chemotherapy cycles(4≥cycles or <4cycles).Result：The1-，2-，and3-year survival rates, of the92patients were68.4％、35.8％、15.2％,respectively． The median survival time was17months (range,1-65months)．Univariate analysis showed that，N stage(P=0.004）,multiple metastatic sites（P=0.00）、 radiotherapy of primary nasopharyngeal tumors(P=0.000) and chemotherapy cycles(P=0.022)were prognostic factors of NPC with distantmetastasis．Multivariate analysis showed that N stage（P=0.006）、multiple metastaticsites（P=0.005）and radiotherapy of primary nasopharyngeal tumors（P=0.018）、chemotherapy cycles (P=0.015) were independent prognostic factors．Conclusion:In this study we identified some prognostic factors in univariate and multivariateanalysis. N stage、multiple metastatic sites、chemotherapy cycles and radiotherapy ofprimary nasopharyngeal tumors were independent prognostic factors．Based on ourresults, radiotherapy to the primary tumor sites could be considered for NPC patientsinitially presenting with distant metastasis (stage M1). A combination of radiotherapyand above4cycles chemotherapy might have potential survival benefits. Furtherrandomized prospective study is necessary to explore the optimal treatment stategy.