Factors determining the survival of nasopharyngeal carcinoma with lung metastasis alone: does combined modality treatment benefit?

We retrospectively reviewed 246 patients of NPC with lung metastasis(es) alone presented at diagnosis or as the first failure after primary treatment from 1993 to 2008 in an academic tertiary hospital. Univariate and multivariate survival analyses of post-metastasis survival (PMS) and overall survival (OS) were carried out to determine the prognostic factors.The 3-year, 5-year, and 10-year of PMS and OS for the whole cohort were 34.3%, 17.0%, 8.6% and 67.8%, 45.4%, 18.5%, respectively. The median PMS (45.6 months vs. 23.7 months) and OS (73.7 months vs. 46.2 months) of patients treated with combined therapy was significantly longer than that of those treated with chemotherapy alone (P < 0.001). Age, disease-free interval (DFI) and treatment modality were evaluated as independent prognostic factors of OS, while only age and treatment modality retain their independent significance in PMS analysis. In stratified survival analysis, compared to chemotherapy alone, combined therapy could benefit the patients with DFI > 1 year, but not those with DFI ≤ 1 year.Age ≤ 45 years, DFI > 1 year, and the combined therapy were good prognostic factors for NPC patients with lung metastasis(es) alone. The combination of local therapy and the basic chemotherapy should be considered for these patients with DFI > 1 year.Nasopharyngeal carcinoma (NPC) is most prevalent in southeastern Asia [1,2], the histology of which is almost World Health Organization (WHO) types III (undifferentiated) [3]. In contrast to other squamous cell carcinoma of the head and neck, NPC is characterized by a high tendency for metastatic dissemination [4,5]. About 5-8% of NPC patients are present with distant metastasis(es) at diagnosis, and 30 to 60% of locally advanced patients will develop distant metastasis(es) and die of disseminated disease [2,4,6]. NPC with distant metastasis makes a very heterogeneous group, of which the post-metastatic survival can vary considerably ranging from weeks to years [7-9].The