The prognostic significance of race in nasopharyngeal carcinoma by histological subtype

Abstract

Background: Race has been shown to have variable prognostic importance in nasopharyngeal carcinoma (NPC). However, previous studies are limited by a lack of comprehensive treatment, epidemiologic, and comorbidity data.

Methods: This was a retrospective cohort study utilizing the National Cancer Database from 2004 to 2016. Multivariable Cox proportional hazards regressions were used to calculate adjusted hazard ratios (aHR) for overall survival.

Results: A cohort of 9995 patients met inclusion and exclusion criteria. Race, insurance, comorbidity, treatment, stage, age, and histology were independent prognosticators. Among patients with keratinizing NPC, Asians and Hispanics had superior survival (aHR 0.58 [95% confidence interval (CI) 0.48-0.69], aHR 0.76 [95% CI 0.61-0.96]) compared to white patients. Among patients with non-keratinizing differentiated NPC, Asians and black patients had improved survival (aHR 0.71 [95% CI 0.56-0.91], aHR 0.72 [95% CI 0.54-0.95]) compared to white patients. Race was not prognostic in non-keratinizing undifferentiated NPC.

Conclusion: The prognostic significance of race varies across histological subtypes of NPC.

Keywords: nasopharyngeal carcinoma; prognosis; race; survival.

Figure 1.

Percentage cases per year for all cases by A) histological subtype, and by race for B) keratinizing NPC, C) non-keratinizing differentiated NPC, and D) non-keratinizing undifferentiated NPC.

Figure 2.

Treatment information stratified by TMN stage and race for A) keratinizing NPC, B) non-keratinizing differentiated NPC, and C) non-keratinizing undifferentiated NPC.

Figure 3.

Kaplan Meier curves for all cases by A) histological subtype, and by race for B) keratinizing NPC, C) non-keratinizing differentiated NPC, and D) non-keratinizing undifferentiated NPC.