Survival and patterns of recurrence in patients with nasopharyngeal carcinoma from a non-endemic region—A German multicenter analysis

Purpose To determine oncological outcomes and patterns of recurrence of nasopharyngeal carcinoma (NPC) in a non-endemic population. Methods MERLIN (DRKS00034782) is a retrospective study initiated by the Young DEGRO that included NPC patients who received definitive radiotherapy between 2004 and 2023. Overall survival (OS) and disease-free survival (DFS) were determined using Kaplan-Meier analyses, while the incidence of treatment failures was analyzed with death as a competing event. Prognostic variables were identified using Cox regression analyses. Results Two hundred ninety-nine patients from 9 centers were analyzed; 274 (92%) were treated with concurrent systemic treatment, while 48 (16%) and 14 (5%) received induction and adjuvant chemotherapy. After a median follow-up of 62 months, 93 deaths, 40 local failures (LF), 19 regional failures (RF), and 41 distant failures (DF) were observed. Most LF (30/40), RF (15/19), and DF (38/41) occurred within the first 3 years after treatment. Five-year OS and DFS rates were 71% and 61%, while the 5‑year incidences of locoregional failures (LRF) and DF were 18% and 14%. In the multivariable analysis, age (HR, 1.03; 95% CI, 1.01–1.05), Karnofsky performance status (≤ 80% vs. ≥ 90%; HR, 1.97; 95%CI, 1.27–3.07), and AJCC/UICC stage (IV vs. I‑III; HR, 2.18; 95%CI, 1.42–3.35) were associated with DFS. Conclusion The rates of LRF and DF in this cohort are similar, and the highest risk for disease progression is within the first 3 years after treatment. Future analyses are needed to assess potential improvements with the use of induction and adjuvant systemic therapy.