Adult versus pediatric nasopharyngeal carcinoma: two clinical entities or one continuum

Purpose: Nasopharyngeal carcinoma (NPC) is rare in children and presents distinct biological and clinical features compared to adults.Comparative outcome data remain limited, particularly regarding patterns of failure. Materials and Methods:We retrospectively analyzed 164 patients with non-metastatic NPC treated at our institution from 2002 to 2023.Patients ≤18 years were classified as pediatric and >18 years as adult (n = 106).All received curative-intent radiotherapy with chemotherapy as per standard protocols.Survival outcomes and failure patterns were compared.Results: A total of 164 NPC patients were included (106 adult and 58 pediatric).Compared to adult NPC, pediatric patients with NPC had more frequent undifferentiated non-keratinizing carcinoma histologic subtype (100% vs. 88.7%,p < 0.01), more Epstein-Barr virus-associated disease (51.7% vs. 29.2%,p < 0.01), and more advanced (cN2-3) nodal category (75.9% vs. 58.5%,p = 0.001).With a median follow-up of 10 years, the 5-year local and regional failures were favorable for pediatric vs. adult group (1.8% vs. 8.7% [p = 0.063] and 0% vs. 8.7% [p = 0.025], respectively).However, distant metastasis was the predominant pattern of failure, and the 5-year distant metastasis rate for pediatric vs. adult NPC was comparable (11.4% vs. 12.4%, p = 0.840), which resulted in no statistically significant differences in event-free survival (85.2% vs. 84.9%,p = 0.370) or overall survival (OS; 90.7% vs. 89.6%,p = 0.380) between pediatric and adult NPC patients.On multivariable analysis, World Health Organization histology and Eastern Cooperative Oncology Group performance status, but not age group, independently predicted outcomes.Conclusion: Pediatrics with NPC achieved favorable locoregional control than adults, yet both groups remained equally vulnerable to distant relapse, leading to similar OS.These findings reinforce the need to further study systemic treatment intensification to reduce distant failure and further improve long-term outcomes.