title: Factors Associated With Mortality in Pediatric vs Adult Nasopharyngeal Carcinoma.
abstract: OBJECTIVE
  Nasopharyngeal carcinoma (NPC) is endemic in some Asian regions but is uncommon in the United States. Little is known about the racial, demographic, and biological characteristics of the disease in pediatric patients.
  
  
  OBJECTIVE
  To improve understanding of the differences between pediatric and adult NPC and to determine whether race conferred a survival difference among pediatric patients with NPC.
  
  
  METHODS
  This retrospective cohort study included all 17 317 patients with a primary diagnosis of NCP in the National Cancer Data Base from January 1, 1998, to December 31, 2011. Of these, 699 patients were 21 years or younger (pediatric); 16 618 patients, older than 21 years (adult). Data were analyzed after data collection.
  
  
  METHODS
  Pediatric age at diagnosis of NPC.
  
  
  METHODS
  Demographic, tumor, and treatment characteristics of pediatric patients with NPC were compared with those of adults using the χ2 test for categorical variables. An adjusted Cox proportional hazards regression model was used to examine survival differences in pediatric patients relative to adult patients. In addition, the risk for pediatric mortality by race was estimated.
  
  
  RESULTS
  Of the 17 317 patients, a total of 699 pediatric and 16 618 adult patients were identified with a primary diagnosis of NPC (female, 239 pediatric patients [34.2%] and 5153 adult patients [32.4%]). Pediatric patients were most commonly black (299 of 686 [43.6%]), whereas adults were most likely to be non-Hispanic white (9839 of 16 504 [60.0%]; P < .001). Pediatric patients were less likely to be Asian (39 of 686 [5.7%]) than were adults (3226 of 16 405 [19.7%]; P < .001). Pediatric patients were more likely to have regional nodal evaluation and to present with stage IV disease (227 of 643 [35.3%] and 330 of 565 [58.4%], respectively) than were adult patients (3748 of 15 631 [24.0%] and 6553 of 13 721 [47.8%], respectively; P < .001 for both comparisons). Pediatric patients had a lower risk for mortality relative to adults (hazard ratio, 0.37; 95% CI, 0.25-0.56). No difference in mortality by racial group was found among pediatric patients (hazard ratio, 1.10; 95% CI, 0.82-1.40).
  
  
  CONCLUSIONS
  Pediatric patients with NPC were more commonly black and presented more frequently with stage IV disease. Pediatric patients had a decreased mortality risk relative to adults, even after adjusting for covariables. Asian race was not associated with increased mortality in pediatric patients with NPC. Racial differences are not associated with an increased risk for mortality among pediatric patients.
authors.affiliation: Department of Surgery, University of Washington, Seattle2Division of Pediatric General and Thoracic Surgery, Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Morgan K
authors.initials: MK
authors.lastname: Richards
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle.
authors.forename: John P
authors.initials: JP
authors.lastname: Dahl
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Gow
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
authors.affiliation: Division of Pediatric Surgery, Methodist Children's Hospital of South Texas, San Antonio.
authors.forename: John
authors.initials: J
authors.lastname: Doski
authors.affiliation: Department of Surgery, John Wayne Cancer Institute, Santa Monica, California.
authors.forename: Melanie
authors.initials: M
authors.lastname: Goldfarb
authors.affiliation: Division of Pediatric Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Jed
authors.initials: J
authors.lastname: Nuchtern
authors.affiliation: Department of Pediatric General Surgery, Maine Children's Cancer Program, Portland.
authors.forename: Monica
authors.initials: M
authors.lastname: Langer
authors.affiliation: Department of Pediatric General Surgery, University of Alabama, Birmingham.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Beierle
authors.affiliation: Division of Pediatric Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Vasudevan
authors.affiliation: Fred Hutchinson Cancer Research Center, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Hawkins
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle.
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Parikh
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002277:Carcinoma; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D055815:Young Adult