Background: Nasopharyngeal carcinoma (NPC) is an uncommon malignancy with a distinct geographical distribution. However, data from non-endemic areas are limited. This study aims to evaluate oncological outcomes and identify prognostic factors in a large cohort of non-metastatic NPC patients treated at a tertiary center in Israel. Methods: This single-institution, retrospective study included 181 patients diagnosed with non-metastatic NPC and treated with radiotherapy between 2005 and 2022. Data were collected from electronic medical records and included demographics, disease characteristics, treatment details, and outcomes. Recurrence-free survival (RFS) and overall survival (OS) were estimated using Kaplan–Meier analysis. Cox proportional hazards models were used to assess prognostic factors. Results: The median follow-up was 57 months. The cohort was predominantly male (82%), with a mean age of 51.7 years. Most patients had non-keratinizing histology, 75%presented with stage III–IV disease, and 86% received concurrent chemoradiotherapy. Induction chemotherapy was administered to 71%, though only 6.5% received the full three-cycle regimen. Nearly 90% were treated using modern radiotherapy techniques (VMAT), and 75% received concurrent chemotherapy. The 3-year RFS and OS were 82.6% and 91.2%, respectively; the 5-year RFS and OS were 77.7% and 84.7%. Age threshold analysis demonstrated that younger age predicted improved RFS (HR range, 3–5;p< 0.05). In the multivariate analysis, patients aged > 50 years had a significantly higher risk of recurrence (HR 6.02, 95% CI 1.30–27.85), while stage IV disease showed a borderline association with poorer RFS (HR 2.81, 95% CI 0.96–8.27), reaching statistical significance in the 30–50 years age group (HR = 7.06, 95% CI 1.14–43.76,p= 0.036). Smoking demonstrated a non-significant trend toward increased recurrence risk (HR 1.61, 95% CI 0.85–3.04). Similar patterns were seen for OS, with age >50 showing elevated but non-significant risk (HR 3.43, 95% CI 0.73–16.06), partly due to limited events. Bedouin ethnicity was associated with higher prevalence and a significantly younger age at diagnosis (39.4 ± 16.0 vs. 52.7 ± 16.9 years,p= 0.004), with a non-significantly better outcome. Conclusions: In this non-endemic cohort, favorable oncologic outcomes were observed. The age at diagnosis is a key prognostic factor. The higher incidence, younger age and better outcomes among the Bedouin ethnicity warrant further investigation calling for improved risk stratification and personalized treatment strategies.
背景：鼻咽癌是一种具有独特地理分布特征的罕见恶性肿瘤，但在非流行地区的数据有限。本研究旨在评估以色列一家三级医疗中心治疗的大规模非转移性鼻咽癌患者的肿瘤学结局，并确定其预后因素。 方法：这项单中心回顾性研究纳入了2005年至2022年间诊断为非转移性鼻咽癌并接受放射治疗的181例患者。数据来源于电子病历，包括人口统计学特征、疾病特征、治疗细节及结局指标。采用Kaplan-Meier法估算无复发生存期和总生存期，并运用Cox比例风险模型评估预后因素。 结果：中位随访时间为57个月。研究队列以男性为主（82%），平均年龄51.7岁。大多数患者为非角化型组织学类型，75%就诊时为III-IV期疾病，86%接受了同步放化疗。71%的患者接受了诱导化疗，但仅6.5%完成了完整的三周期方案。近90%采用现代放疗技术（容积旋转调强放疗），75%接受同步化疗。3年无复发生存率和总生存率分别为82.6%和91.2%；5年无复发生存率和总生存率分别为77.7%和84.7%。年龄阈值分析显示，较低年龄预示更好的无复发生存期（风险比范围3-5，p<0.05）。多变量分析中，年龄>50岁患者复发风险显著增高（风险比6.02，95%置信区间1.30-27.85），而IV期疾病与较差无复发生存期呈临界相关性（风险比2.81，95%置信区间0.96-8.27），在30-50岁年龄组达到统计学显著性（风险比7.06，95%置信区间1.14-43.76，p=0.036）。吸烟显示增加复发风险的非显著性趋势（风险比1.61，95%置信区间0.85-3.04）。总生存期呈现相似规律，年龄>50岁显示风险升高但未达显著性（风险比3.43，95%置信区间0.73-16.06），部分归因于事件数有限。贝都因族裔患者呈现更高患病率及显著更低的诊断年龄（39.4±16.0岁 vs 52.7±16.9岁，p=0.004），其临床结局呈非显著性改善趋势。 结论：在此非流行地区队列中观察到良好的肿瘤学结局。诊断年龄是关键预后因素。贝都因族裔患者更高的发病率、更低的诊断年龄及更好的临床结局值得深入研究，提示需要改进风险分层并制定个体化治疗策略。
肿瘤(癌症)患者之家