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Asian Versus Non-Asian Outcomes in Nasopharyngeal Carcinoma: A North American Population-based Analysis

Hamilton, Sarah N. MD; Ho, Cheryl MD; Laskin, Janessa MD; Zhai, Yongliang MSc; Mak, Paul; Wu, Jonn MD

American Journal of Clinical Oncology: December 2016 - Volume 39 - Issue 6 - p 575–580
doi: 10.1097/COC.0000000000000091
Original Articles: Head and Neck

Objectives: The effect of ethnicity on nasopharyngeal cancer (NPC) outcomes is unclear. This retrospective analysis examines survival and the impact of concurrent chemoradiation (chemoRT) among Asian and non-Asian patients.

Methods: Subjects included 380 consecutive patients with NPC treated at a Canadian institution from 2000 to 2009. Five-year Kaplan-Meier progression-free survival (PFS), disease-specific survival (DSS), and overall survival (OS) were compared between Asian (n=279) and non-Asian (n=101) subjects. Multivariable analysis was performed using Cox regression modeling. Two-variable interaction terms with concurrent chemoRT were used to examine whether concurrent chemoRT conferred different effects among subgroups.

Results: Asian subjects presented with earlier stage (P=0.005), were younger, had better performance status, and were less likely smokers (all P<0.001). Survival among Asian versus non-Asian subjects with stage I/II NPC were: PFS 68% versus 59% (P=0.04), DSS 87% versus 77% (P=0.08), and OS 84% versus 74% (P=0.003). Corresponding rates with stage III/IVA/IVB disease were PFS 49% versus 42% (P=0.12), DSS 72% versus 46% (P=0.001), and OS 70% versus 44% (P<0.001). On multivariable analysis, Asian ethnicity, age below 65 years, ECOG performance status 0-1, early stage, staging MRI use, and concurrent chemoRT were associated with improved DSS and OS (P<0.05). On testing interactions with concurrent chemoRT, Asian versus non-Asian ethnicity was significant (hazard ratio 3.9), suggesting that concurrent chemoRT conferred more benefit among non-Asian compared with Asian subjects.

Conclusions: In this population-based study, Asian ethnicity was associated with improved DSS and OS. Concurrent chemoRT conferred more benefit among non-Asian compared with Asian subjects.

*Departments of Radiation Oncology

Medical Oncology

Population Oncology—Surveillance and Outcomes, British Columbia Cancer Agency

§Department of Medicine

Department of Surgery, University of British Columbia, Vancouver, BC, Canada

Department of Statistics

The authors declare no conflicts of interest.

Presented in part at the 2013 American Society for Radiation Oncology Annual Meeting, September 22–25, 2013, Atlanta, GA.

Reprints: Sarah N. Hamilton, MD, Radiation Therapy Program, BC Cancer Agency, 600 West 10th Ave, Vancouver, BC, Canada V5Z 4E6. E-mail:

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