Systemic chemotherapy is the basic palliative treatment for metastatic nasopharyngeal carcinoma(NPC); however, it is not known whether locoregional radiotherapy targeting the primary tumor and regional lymph nodes affects the survival of patients with metastatic NPC. Therefore, we aimed to retrospectively evaluate the benefits of locoregional radiotherapy. A total of 408 patients with metastatic NPC were included in this study. The mortality risks of the patients undergoing supportive treatment and those undergoing chemotherapy were compared with that of patients undergoing locoregional radiotherapy delivered alone or in combination with chemotherapy. Univariate and multivariate analyses were conducted. The contributions of independent factors were assessed after adjustment for covariates with significant prognostic associations (P<0.05). Both locoregional radiotherapy and systemic chemotherapy were identified as significant independent prognostic factors of overall survival(OS). The mortality risk was similar in the group undergoing locoregional radiotherapy alone and the group undergoing systemic chemotherapy alone [multi-adjusted hazard ratio(HR)=0.9, P=0.529]; this risk was 60% lower than that of the group undergoing supportive treatment(HR=0.4, P=0.004) and 130% higher than that of the group undergoing both systemic chemotherapy and locoregional radiotherapy(HR=2.3, P<0.001). In conclusion, locoregional radiotherapy, particularly when combined with systemic chemotherapy, is associated with improved survival of patients with metastatic NPC.
Introduction:Patients with metastatic nasopharyngeal carcinoma(NPC)have variable survival outcomes.We have previously shown that an elevated peripheral blood lymphocyte-to-monocyte ratio(LMR)is associated with an increased metastatic risk in patients with primary NPC.The present study aimed to investigate the prognostic value of pretreatment LMR in a large cohort of metastatic NPC patients.Methods:Clinical data of 672 patients with metastatic NPC diagnosed between January 2003 and December2009 were analyzed.The peripheral lymphocyte and monocyte counts were retrieved,and LMR was calculated.Receiver operating characteristic(ROC)curve analysis and univariate and multivariate COX proportional hazards analyses were performed to evaluate the association of LMR with overall survival(OS).Results:Univariate analysis revealed that an elevated absolute lymphocyte count(≥1.390×109/L)and LMR(≥2.475)as well as a decreased monocyte count(<0.665×109/L)were significantly associated with prolonged OS.Multivariate Cox proportional hazard analysis showed that LMR(hazard ratio[HR]=0.50,95%confidence interval[CI]=0.41–0.60,P<0.001),absolute lymphocyte count(HR=0.77,95%CI=0.64–0.93,P=0.007),and monocyte count(HR=1.98,95%CI=1.63–2.41,P<0.001)were independent prognostic factors.By stratification analyses,only LMR remained a significant predictor of prognosis.Conclusion:We identified pretreatment LMR as an independent prognostic factor for patients with metastatic NPC.Independent validation of our findings is needed.
