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Regular post-treatment surveillance is associated with improved survival in nasopharyngeal carcinoma: a retrospective
Chen-Fei Wu1, Qiu-Yi Pan1, Yu-Xian Yang1
1Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, PR China; Department of Radiation Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, PR China.
Purpose:
Benefit of post-treatment surveillance in nasopharyngeal carcinoma (NPC), characterized by high recurrence risk, remains unexplored. We explored whether regular post-treatment surveillance facilitates earlier recurrence detection and improves survival.
Methods And Materials:
We identified 8,798 patients with non-metastatic stage I-IVA NPC at Sun Yat-sen University Cancer Center. The 1-year landmark analysis was chosen as representative of surveillance patterns, dividing patients into regular and irregular surveillance group based on surveillance intensity. Cox proportional hazards models clarified the association between overall survival (OS) and surveillance intensity, with subgroup analyses stratified by clinical stage and pretreatment Epstein-Barr virus DNA level. Survival impact of surveillance imaging for local, regional, and distant sites were also investigated.
Results:
Median follow-up was 64.8 months. 1-year landmark analysis comprised 4,078 and 4,720 patients receiving regular (≥ 4 visits in the first year) and irregular surveillance (< 4 visits), respectively. Regular surveillance was linked to shorter median recurrence time (26.1 versus 27.0 months) and improved OS (HR, 0.86; 95% CI, 0.74-0.99; P = 0.032) after multivariable adjustment. Notably, patients receiving regular imaging surveillance for distant site had better OS (HR, 0.69; 95% CI, 0.57-0.82; P < 0.001) whereas imaging for local (HR, 1.36; 95% CI, 0.90-2.04; P = 0.140) and regional site (HR, 0.85; 95% CI, 0.57-1.27; P = 0.428) did not. Regular surveillance patients with distant metastases exhibited fewer metastatic organs (P < 0.001) and earlier recurrence stages (P < 0.001), translating into prolonged post-recurrence survival (HR, 0.68; 95% CI, 0.58-0.80; P < 0.001).
Conclusions:
Regular post-treatment surveillance, particularly distant imaging, could improve NPC survival, highlighting an urgency for evidence-based post-treatment surveillance strategies.