Impact of nodal ratio on survival in recurrent nasopharyngeal carcinoma.

Background: The purpose of this study was to investigate if nodal ratio has a prognostic role in the survival of patients with recurrent nasopharyngeal carcinoma (NPC) in the neck.

Methods: Patients with recurrent NPC in the neck who were treated in Queen Mary Hospital from 2000 to 2011 were identified. Clinical data, pathological results, and survival outcome were analyzed.

Results: Only nodal ratio remained as a statistically significant predictor in multivariate analysis for nodal recurrence (p = .045) and nodal recurrence-free survival (p = .010). All other predictors lost significance when compared with each other and with nodal ratio. Nodal ratio was also a significant predictor for overall survival (OS) in univariate analysis (p = .001) but lost its significance in multivariate analysis. The cutoff points 10% and 15% effectively stratified the patients into 3 risk groups (p = .02).

Conclusion: In patients with NPC with neck recurrence, nodal ratio (the ratio of positive nodes to the total number of nodes examined) is a strong predictor of further nodal recurrence and nodal recurrence-free survival. Nodal ratio also impacts the OS but loses its significance in multivariate analysis, including concurrent local recurrence. Stratification of patients into low, medium, and high-risk groups according to nodal ratio may have a potential role in guiding therapeutic decision-making. Therefore, further exploration in this area is warranted.