Survival determinants and treatment patterns in a European multi-center cohort of patients with nasopharyngeal carcinoma

Background: Nasopharyngeal carcinoma (NPC) is a distinct head and neck malignancy characterized by marked geographic and ethnic variability, with most studies originating from endemic Asian regions. However, the disease also occurs in non-endemic populations, where prognostic factors and treatment outcomes may differ. This study aimed to evaluate overall survival (OS) in a European multi-institutional cohort of patients with NPC and to assess the impact of disease stage and chemotherapy exposure on survival outcomes. Methods: A retrospective multicenter study was conducted including patients diagnosed with NPC in six oncology centers across Romania, Italy, Spain, and the United Kingdom. Eligible patients had histologically confirmed NPC and a minimum follow-up of five years. Clinical, demographic, staging, and treatment data were collected from medical records. OS was estimated using the Kaplan-Meier method and compared using the log-rank test. Univariable and multivariable Cox proportional hazards regression analyses were performed to identify prognostic factors. Results: A total of 416 patients were included, with a mean age of 48.2 years and a predominance of males (68%). Most patients presented with advanced-stage disease (83.7%). Concurrent chemotherapy was administered in 73.3% of cases. Median survival was 204 months in patients receiving chemotherapy and 187 months in those without chemotherapy, with no significant difference between groups (p = 0.85). Chemotherapy exposure was not independently associated with OS in multivariable analysis. Increasing age was identified as an independent prognostic factor associated with higher mortality risk (HR 1.03 per year, p < 0.001). Conclusions: In this European multicenter cohort, OS in NPC patients was primarily influenced by age, as demonstrated by independent multivariable Cox regression (HR 1.03 per year, p < 0.001), while concurrent chemotherapy was not independently associated with improved survival. Disease stage was used as a stratification variable in the multivariable model to account for non-proportional hazards; accordingly, no hazard ratio for stage is estimated. Kaplan-Meier analysis suggested higher survival probabilities in early-stage disease, though this difference did not reach statistical significance (log-rank p = 0.099). Further prospective studies are needed to clarify the role of systemic therapy in non-endemic populations.