PROGNOSTICATORS DETERMINING SURVIVAL SUBSEQUENT TO DISTANT METASTASISFROM NASOPHARYNGEAL CARCINOMA

BACKGROUND. Distant metastases are common in patients with nasopharyng eal carcinoma (NPC), and their presence is the most important factor i n limiting survival. We aimed to study the prognosticators determining survival subsequent to distant metastasis from NPC. METHODS. A study by both mono- and multivariate analyses was carried out in 945 patient s presenting between 1984 and 1989. Forty-two presented with metastase s and 247 developed metastasis after primary radiotherapy. RESULTS. Pa tients who presented with distant metastasis (M1-classification) had a significantly shorter survival than those who developed metastases af ter primary radiotherapy. The presence of hepatic metastases, short me tastasis free interval, and older age at presentation significantly pr edicted short survival after the diagnosis of distant metastasis. Pati ents with metastases preceded by, and/or accompanied with, locoregiona l recurrence had comparable survival to those without, despite their a ssociation with a significantly longer metastasis free interval. A his tory of locoregional recurrence was however not compatible with long t erm, disease free survival, and, in its presence, advanced T-classific ation on presentation predicted poor survival subsequent to metastasis . Long term disease free survival (64-117 months) was attained in 4 yo ung patients (age < 40 years) with isolated intrathoracic metastases i n the absence of locoregional recurrence after achieving a complete re sponse to aggressive treatment, with chemotherapy, radiotherapy, and/o r surgery, usually multimodal. CONCLUSIONS. Some of the clinical progn osticators have been identified and an attempt was made to subclassify distant metastases according to possible differences in prognosis. A subset of metastatic NPC was identified which is compatible with long term, disease free survival. Investigations during follow-up should be directed toward the early detection of such potentially salvageable c ases. (C) 1996 American Cancer Society.