Real-world outcomes of nasopharyngeal carcinoma in a 20-year retrospective cohort from a lower-middle income country.

e18093 Background: Nasopharyngeal carcinoma (NPC) is frequently diagnosed at advanced stages in low- and middle-income countries (LMICs), where real-world treatment delivery challenges may further impact outcomes. Long-term outcome data from LMIC settings remain limited. We evaluated clinicopathologic characteristics, treatment patterns, and survival outcomes of NPC patients treated at a tertiary care center over two decades. Methods: This retrospective observational cohort included patients with histologically confirmed NPC diagnosed between January 2006 and December 2025. Demographics, stage, histology, treatment modality, and outcomes were abstracted from institutional records. Treatments included radiotherapy alone, concurrent chemoradiotherapy (CCRT), and systemic therapy, according to disease stage and clinical status. Overall survival (OS) was estimated using Kaplan-Meier methodology, with exploratory analyses by stage and treatment factors. Results: Eighty four patients were included; median age was 45 years, with male predominance (76%). Most patients presented with advanced disease, with 87% diagnosed at stage III–IV, including approximately 18% with metastatic disease at presentation. The predominant histologic subtype was non-keratinizing/undifferentiated carcinoma (>90%). Among non-metastatic patients, CCRT was the primary treatment in nearly 80%, reflecting guideline-concordant care. Median OS for the entire cohort was 23.5 months, with a clear stage-dependent survival gradient. Patients presenting with metastatic disease had poor outcomes despite systemic therapy. Among initially non-metastatic patients, recurrence occurred in approximately one-quarter, with failures predominantly distant rather than local, suggesting effective locoregional control but ongoing risk of systemic relapse. Treatment interruptions and delays, reflective of real-world practice constraints, were frequently observed and were associated with inferior survival. Conclusions: In this large real-world LMIC cohort, most NPC patients presented with advanced disease, and distant metastasis remained the dominant pattern of failure despite effective locoregional therapy. Outcomes were further compromised by treatment delays and interruptions. These findings highlight the need for earlier diagnosis, improved systemic strategies, and strengthened multidisciplinary treatment delivery to improve survival in resource-limited settings.