Familial Nasopharyngeal Carcinoma 6

Prognostic Factors in Nasopharyngeal Cancer 9Jin-Ching LinCONTENTS9.1 Introduction 959.2 Presenting Stage as a PrognosticFactor 969.3 Predictive Value of the Volumes of thePrimary Disease and Cervical LymphAdenopathy on Prognosis 979.4 Predictive Value of Tumor Markers andMolecular Indicators on Prognosis 1039.4.1 Anti-EBV Antibody 1039.4.2 Tumor-Associated Genesin Peripheral Blood Cells 1069.4.3 Plasma/Serum EBV DNA 1079.4.4 Other Serum/Plasma Biomarkers 1099.4.5 Tissue Prognostic Biomarkers 1119.5 Other Implicated Prognostic Factors 1119.5.1 Patient-Related Factors 1119.5.1.1 Age 1119.5.1.2 Gender 1169.5.1.3 Ethnic Background 1169.5.1.4 Performance Status, WeightLoss, and Anemia 1179.5.2 Pathology 1189.5.3 Factors Associated withDiagnostic Procedures 1209.5.3.1 Parapharyngeal Space Invasionor RetropharyngealLymphadenopathy 1209.5.3.2 Other Adjacent StructuresInvolvement 1229.5.3.3 Implication of MRI and PET Scan 1229.5.4 Treatment-Related Factors 1239.5.4.1 Radiotherapy-Related Factors 1239.5.4.2 Chemotherapy-Related Factors 1279.6 Summary 128References 128Jin-Ching Lin, MD, PhDDepartment of Radiation Oncology, Taichung VeteransGeneral Hospital, Taiwan, No. 160, Sec. 3, Taichung-Kang Rd.,Taichung 407, Taiwan, ROC9.1IntroductionThe prognosis of a cancer depends on the biologicalaggressiveness of the tumor, the characteristic of thehost, and the therapeutic interventions. Prognosticfactors of nasopharyngeal carcinoma (NPC) have beenone of the most important research foci, and a largenumber of investigations in this area have been performedand published. The extent of local invasion,regional lymphatic spread, and distant metastasis,as reflected by the TNM staging, are the most importantprognostic factors in NPC. Generally, advancedT-classification is associated with worse local controland overall survival; advanced N-classification predictsincreased risk of both distant failure and suboptimalsurvival; and patients with distant metastasis,that is, M1 disease usually are not curable and havelimited life expectancy. In addition, advances in imagingmodalities, such as computerized tomography(CT) scan, magnetic resonance imaging (MRI), andpositron emission tomography (PET) scan, make itpossible to measure tumor volume and extension moreprecisely. A number of radiological criteria other thanthose required by the TNM staging have been reportedto affect treatment outcome significantly. Furthermore,NPC has been proven as an EBV-associated disease.Recently, cell-free circulating EBV DNA has beendetected in plasma and serum of NPC patients, andhas been shown as a reliable prognosticator.Because of the anatomic constraints of NPC andits high radiosensitivity, NPC is traditionally treatedby radiation therapy. Advances in radiation technologyand fractionation schedule have significantlyimproved the treatment results. NPC is a chemosensitivemalignancy as well, and chemotherapy hasbeen incorporated into the management of advanceddisease. Various strategies of combined chemoradiationtherapy have demonstrated a different impact