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Poster Discussion – Head and neck cancer

3107 - Survival and prognostic factors of nasopharyngeal cancer patients in non-endemic countries: a large multicentric database analysis


28 Sep 2019


Poster Discussion – Head and neck cancer


Paolo Bossi


Annals of Oncology (2019) 30 (suppl_5): v449-v474. 10.1093/annonc/mdz252


P. Bossi1, S. Grisanti1, I. Mohamad2, I. Linares Galiana3, E. Ozyar4, P. Franco5, S. Vecchio6, L. Livi7, B. Cirauqui Cirauqui8, M. El-Sherify9, S. Ursino10, A. Argiris11, J. Pan12, C. Wittekindt13, E. D'Angelo14, M. Buglione15, M. Airoldi16, R. Mesia Nin17, L.F. Licitra18, E. Orlandi19

Author affiliations

  • 1 Medical Oncology Dept., Azienda Ospedaliera Spedali Civili di Brescia, 25123 - Brescia/IT
  • 2 Radiation Oncology Dept., King Hussein Cancer Center, Amman/JO
  • 3 Medical Oncology, Institut Català d’Oncologia Hospital Duran i Reynals, Barcelona/ES
  • 4 Radiation Oncology Dept., ACIBADEM University, Istanbul/TR
  • 5 Radiation Oncology Dept., University of Turin, Torino/IT
  • 6 Oncology, IRCCS AOU San Martino - IST-Istituto Nazionale per la Ricerca sul Cancro, 16132 - Genova/IT
  • 7 Radiation Oncology, AOU Careggi - Radioterapia Oncologica, 50121 - Firenze/IT
  • 8 Medical Oncology Department, Catalan Institute of Oncology (ICO)., Badalona/ES
  • 9 Radiation Oncologist Department, Kuwait Cancer Control Centre Al Sabah Hospital, 70653 - Shuwaikh/KW
  • 10 Radiation Oncology Dept., Azienda Ospedaliero-Universitaria PIsana, Pisa/IT
  • 11 Medical Oncology, Hygeia Hospital, 151 23 - Athens/GR
  • 12 Radiation Oncology Dept., Thomas Jefferson University, Philadelphia/US
  • 13 Otorhinolaryngology, University Hospital Giessen, 35390 - Giessen/DE
  • 14 Radiation Oncology Dept., Azienda Ospedaliero-Univeristaria Modena Policlinico, Modena/IT
  • 15 Radiation Oncology Dept., Azienda Ospedaliera Spedali Civili di Brescia, 25123 - Brescia/IT
  • 16 Medical Oncology, AOU S. Giovanni Battista - Molinette, 10126 - Torino/IT
  • 17 Medical Oncology Department, Institut Català d'Oncologia, Badalona/ES
  • 18 Head And Neck Medical Oncology Unit, Istituto Nazionale dei Tumori di Milano - Fondazione IRCCS, 20133 - Milan/IT
  • 19 Radiation Oncology Dept., Istituto Nazionale dei Tumori di Milano - Fondazione IRCCS, 20133 - Milan/IT


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Abstract 3107


Nasopharyngeal carcinoma (NPC) is a rare cancer in many areas including Europe and Middle East/Mediterranean. Data regarding natural history, prognostic factors and treatment strategies in NPC patients (pts) are derived mostly from studies conducted in endemic regions.


We collected clinical data on consecutive NPC pts treated in non-endemic countries from 2005 to 2016. Main objective of the study was to collect clinical/biological parameters and to correlate them with the outcome, at uni- and multivariate analysis, using the Cox regression model.


The database included 1220 pts from 34 Centers. They were mainly male (72%), with ECOG performance status (PS) 0 in 74% of the cases, with advanced stages (stage III 42%, IV 33%), and with a median age of 50 years. Tumoral EBER was assessed in 51% (42% positive); plasmatic EBV DNA was evaluated at baseline in 23% of the pts, with a mean value of 12,434 copies/mL (range 0-824,525). Induction, concurrent and adjuvant chemotherapy (CT), were administered to 45%, 83% and 11% of the pts, respectively. Main RT techniques employed were IMRT (81%) and 3DRT (19%). With a median follow up of 56.5 months, 3- and 5-year overall survival (OS) was 83% and 77%, respectively. Among the 411 pts who relapsed, distant metastases were the pattern of failure in 55%, with bone (49%), lung (31%) and liver (29%) as the most represented sites. At relapse, main treatment approach was CT (45%), surgery (24%), re-RT (9%), or supportive care only (10%). At univariate analysis, prognostic factors favorably correlated with OS were: PS (0-1 vs > 1, p < 0.0001); female sex (p = 0.001); global stage (I-II vs III vs IV, p < 0.0001), T stage (T1-T2 vs T3-T4, p < 0.0001), N stage (N0-N1 vs N2-N3, p = 0.0242), baseline plasmatic EBV > 4000 copies/mL (p = 0.0073). At multivariate analysis, all the variables confirmed their prognostic value.


In non-endemic countries, NPC showed survival figures comparable to endemic areas. Stage, PS, gender and plasmatic EBV DNA turned out to be prognostic factors. These data represent the benchmark in non-endemic setting and the referral for building new prospective trials.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Fondazione IRCCS Istituto Nazionale Tumori Milano.


Has not received any funding.


P. Bossi: Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: BMS; Advisory / Consultancy: MSD; Advisory / Consultancy: Angelini; Advisory / Consultancy: Merck; Advisory / Consultancy: Voluntis. R. Mesia Nin: Advisory / Consultancy, Speaker Bureau / Expert testimony: Merck; Advisory / Consultancy, Speaker Bureau / Expert testimony: BMS; Advisory / Consultancy, Speaker Bureau / Expert testimony: MSD; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Roche; Advisory / Consultancy: Nanobiotix; Advisory / Consultancy: Nanobiotix; Advisory / Consultancy: Nanobiotix. L.F. Licitra: Honoraria (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: BMS; Honoraria (self), Research grant / Funding (institution): EISAI; Honoraria (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: MSD; Honoraria (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: Merck Serono; Honoraria (self), Research grant / Funding (institution): Boehringer; Honoraria (self), Research grant / Funding (institution): Novartis; Honoraria (self), Research grant / Funding (institution): AstraZeneca; Honoraria (self), Research grant / Funding (institution): Roche; Honoraria (self), Research grant / Funding (institution): Bayer; Honoraria (self), Travel / Accommodation / Expenses: Debiopharm; Honoraria (self), Travel / Accommodation / Expenses: Sobi; Honoraria (self): Doxa Pharma srl; Honoraria (self): Nanobiotics; Honoraria (self): GSK; Research grant / Funding (institution): Celgene; Research grant / Funding (institution): Exelixis Inc.; Research grant / Funding (institution): Hoffmann-La Roche Ltd.; Research grant / Funding (institution): IRX Therapeutics, Inc.; Research grant / Funding (institution): Medpace INC.; Research grant / Funding (institution): Pfizer; Travel / Accommodation / Expenses: Stilema, AccMed, Aiocc, Aiom; Honoraria (self): Amgen. All other authors have declared no conflicts of interest.

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