title: Clinical Outcome among Nasopharyngeal Cancer Patients in a Multi-Ethnic Society in Singapore.
abstract: BACKGROUND
  Nasopharyngeal cancer (NPC) is endemic among Chinese populations in Southeast Asia. However, the outcomes of non-Chinese NPC patients in Singapore are not well reported.
  
  
  OBJECTIVE
  To determine if non-Chinese NPC patients have a different prognosis and examine the clinical outcomes of NPC patients in a multi-ethnic society.
  
  
  METHODS
  Retrospective chart review of 558 NPC patients treated at a single academic tertiary hospital from 2002 to 2012. Survival and recurrence rates were analysed and predictive factors identified using the Kaplan-Meier method and Cox regression model.
  
  
  RESULTS
  Our cohort comprised 409 males (73.3%) and 149 females (26.7%) with a median age of 52 years. There were 476 Chinese (85.3%), 57 Malays (10.2%), and 25 of other ethnic groups (4.5%). Non-Chinese patients were more likely to be associated with advanced nodal disease at initial presentation (p = 0.049), compared with the Chinese. However, there were no statistical differences in their overall survival (OS) or disease specific survival (DSS) (p = 0.934 and p = 0.857 respectively). The 3-year and 5-year cohort OS and DSS rates were 79.3%, 70.7%, and 83.2%, 77.4% respectively. Advanced age (p<0.001), N2 disease (p = 0.036), N3 disease (p<0.001), and metastatic disease (p<0.001) at presentation were independently associated with poor overall survival. N2 disease (p = 0.032), N3 disease (p<0.001) and metastatic disease (p<0.001) were also independently associated with poor DSS. No predictive factors were associated with loco-regional recurrence after definitive treatment. Advanced age (p = 0.044), N2 disease (p = 0.033) and N3 disease (p<0.001) were independently associated with distant relapse.
  
  
  CONCLUSIONS
  In a multi-ethnic society in Singapore, non-Chinese are more likely to present with advanced nodal disease. This however did not translate into poorer survival outcomes. Older patients with N2 or N3 disease are associated with a higher risk of distant relapse and poor overall survival.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, National University Health System, Singapore, Singapore.
authors.forename: Han Wen
authors.initials: HW
authors.lastname: Mak
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, National University Health System, Singapore, Singapore.
authors.forename: Shan Hui
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, National University Health System, Singapore, Singapore.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Chee
authors.affiliation: Department of Radiation Oncology, National University Health System, Singapore, Singapore.
authors.forename: Ivan
authors.initials: I
authors.lastname: Tham
authors.affiliation: Department of Hematology and Oncology, National University Health System, Singapore, Singapore.
authors.forename: Boon Cher
authors.initials: BC
authors.lastname: Goh
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, National University Health System, Singapore, Singapore.
authors.forename: Siew Shuen
authors.initials: SS
authors.lastname: Chao
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, National University Health System, Singapore, Singapore.
authors.forename: Yew Kwang
authors.initials: YK
authors.lastname: Ong
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, National University Health System, Singapore, Singapore.
authors.forename: Kwok Seng
authors.initials: KS
authors.lastname: Loh
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, National University Health System, Singapore, Singapore.
authors.forename: Chwee Ming
authors.initials: CM
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D018572:Disease-Free Survival; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D009362:Neoplasm Metastasis; D012846:Singapore; D062606:Tertiary Care Centers; D016896:Treatment Outcome