Familial Nasopharyngeal Carcinoma 6

118 J-C. Lincontaining 59 NPC patients reported that the comorbidityburden did not affect prognosis independent ofthe TNM staging (Ramakrishnan et al. 2007). Areport from Australia failed to demonstrate significanteffect of performance status on failure-free survival(Corry et al. 2006). Yi et al. (2006) retrospectivelyreviewed clinical outcome of 905 NPC patients treatedby radiation alone during 1990 to 1999 from MainlandChina. Karnofsky performance status, weight loss, andhemoglobin level had no significant effect on overalland disease-free survival by multivariate analysis.Chow et al. (2002) from Canada reported weight lossas a poor prognostic factor on overall and disease-freesurvival. Johansen et al. (2001) from Denmark demonstratedthat patients with higher pretreatmenthemoglobin level had higher 5-year local control ratethan those with lower hemoglobin level (75% vs. 58%,p < 0.05). Chua et al. (2004a) investigated the impactof hemoglobin levels on treatment outcome by retrospectivelyreviewing the data from a Phase III randomizedtrial of patients treated with inductionchemotherapy followed by radiation or radiationalone, and found no significant difference in treatmentoutcome according to baseline or preradiotherapyhemoglobin levels. However, a mid-radiation hemoglobinlevel of 98% of all patients). Thus it is difficultto validate the findings of nonendemic regions.The distinction between WHO Types 2 and 3 is notclear. NPC is not a surgically treated disease. Thespecimen by punch biopsy for pathological diagnosisis only a tiny part from a big tumor. In our experience,tumors of most patients showed mixed morphologyof Type 2 and 3 in different portions of thesame specimen. In addition, some controversy existedbetween different pathologists to differentiate theType 2 and 3 because a large variation between theproportions of Type 2 and 3 from different hospitalsof the same regions was reported.Epidemiological studies containing more than 1000patients from the SEER of the United States orEUROCARE database have identified WHO histologicaltype as an independent prognostic factor for survivalin NPC (Levine et al. 1980, Burt et al. 1992;Marks et al. 1998; Lee and Ko 2005; Ou et al. 2007;Jiong et al. 1998). Patients with nonkeratinizing orundifferentiated carcinoma of the nasopharynx havesignificantly better survival than those with keratinizingcarcinoma. Marks et al. (1998) reported that the5-year rates of overall survival for Type 1, 2, and 3patients were 37%, 65%, and 64%, respectively (p