Abstract
BACKGROUND: The prognostic impact of internal carotid artery (ICA) invasion in nasopharyngeal cancer (NPC) patients is not well established. Thus, we conducted a retrospective study to analyze the prognostic factors for ICA invasion by NPC. METHODS: This retrospective study included consecutive biopsy-proven NPC patients who received CCRT from November 2015 to December 2022 at E-Da Hospital. Patients were then classified into two groups according to ICA invasion by tumor or not. Survival was estimated by the Kaplan-Meier method with a five-year overall survival (OS) rate and five-year disease specific survival (DSS) rate. RESULTS: A total of 191 patients with pathologically confirmed NPC were included in this study, with 54 patients in the ICA invasion group and 137 patients in the no ICA invasion group. The ICA invasion group showed a worse prognosis compared to the no ICA invasion group (p < 0.001 in OS and DSS). Patients were stratified into a poor response group and good response group. OS and DSS in the poor response group had a significant difference compared to the good response group (both p < 0.001). In multivariate analysis, NLR was an independently prognostic factor for OS (HR 2.430, 95% CI 1.040-5.678, p = 0.040 and HR 0.412, 95% CI 0.176-0.962, p = 0.040, respectively) and for DSS (HR 2.430, 95% CI 1.040-5.678, p = 0.040 and HR 0.412, 95% CI 0.176-0.962, p = 0.040, respectively). CONCLUSIONS: Locally advanced NPC patients with ICA invasion have a miserable outcome and NLR represents a significant prognostic factor that impacts treatment decisions and survival.