{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T22:41:33Z","timestamp":1792622493464,"version":"4.5.0"},"reference-count":21,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Nasopharyngeal carcinoma (NPC) displays marked geographic and histopathological heterogeneity, and prognostic determinants in non-endemic regions remain incompletely defined. This study aimed to evaluate the impact of clinicopathological characteristics and treatment modalities on survival outcomes among patients with stage II\u2013IVA NPC treated with curative intent at a single tertiary cancer center. Materials and Methods: A retrospective analysis was conducted on 81 consecutive patients with histologically confirmed NPC treated between 2000 and 2022. Demographic, clinical, and treatment parameters were extracted from institutional records. Survival outcomes\u2014including disease-free survival (DFS), locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), cancer-specific survival (CSS), and overall survival (OS)\u2014were estimated using the Kaplan\u2013Meier method and compared using the log-rank test. Prognostic variables identified in univariate analysis were further assessed by multivariable Cox proportional hazards regression (Cox\u2019s model). Results: The cohort included 59 men (72.8%) and 22 women (27.2%), with a median age of 50.8 years (range, 19\u201378). Most patients presented with locally advanced disease (T3\u2013T4, 53.1%; N2, 60.5%; stage III\u2013IVA, 87.7%). Non-keratinizing undifferentiated carcinoma (World Health Organization [WHO] type III) was the predominant histology (71.6%), followed by the non-keratinizing differentiated subtype (17.3%). Median DFS and OS were 94.6 and 139.4 months, respectively. According to the univariate analysis, histological subtypes and a family history of cancer were significantly associated with DFS, whereas comorbid systemic disease showed an unexpected association with longer DMFS. The multivariable Cox model identified the histological subtype as an independent predictor of disease recurrence (HR = 2.23, 95% CI: 1.00\u20134.94; p = 0.049). For OS, both histological subtype (HR = 2.40, 95% CI: 1.10\u20135.25; p = 0.029) and age at diagnosis (HR = 1.05, 95% CI: 1.02\u20131.09; p = 0.005) were independent adverse prognostic factors. Conclusions: In this long-term, single-center study from a non-endemic region, histological subtype emerged as the most powerful determinant of prognosis, significantly influencing both DFS and OS. Patients with non-keratinizing undifferentiated (WHO type III) carcinoma demonstrated superior outcomes compared with those with differentiated histology. Additionally, increasing age at diagnosis was independently associated with poorer OS. In contrast, inflammatory and nutritional biomarkers, the Pan-Immune\u2013Inflammation Value (PIV) and the Prognostic Nutritional Index (PNI), showed no prognostic significance. These findings underscore the continued prognostic relevance of histopathologic classification and age and highlight the need for large-scale, standardized studies integrating Epstein\u2013Barr virus (EBV) status and host-related factors in non-endemic NPC populations.<\/jats:p>","DOI":"10.3390\/medicina61122207","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T10:11:23Z","timestamp":1765793483000},"page":"2207","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prognostic Value of Histological Subtypes and Clinical Factors in Non-Endemic Nasopharyngeal Carcinoma: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8575-5477","authenticated-orcid":false,"given":"Seda","family":"Sali","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, University of Health Sciences, Bursa City Education and Research Hospital, Bursa 16250, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5380-5898","authenticated-orcid":false,"given":"Candan Demir\u00f6z","family":"Abakay","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, School of Medicine, Bursa Uluda\u011f University, G\u00f6r\u00fckle, Nil\u00fcfer, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2079-3350","authenticated-orcid":false,"given":"M\u00fcrsel","family":"Sali","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Bursa Uluda\u011f University, G\u00f6r\u00fckle, Nil\u00fcfer, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3181-2660","authenticated-orcid":false,"given":"Hakan","family":"G\u00fcd\u00fcc\u00fc","sequence":"additional","affiliation":[{"name":"Department of \u0130nternal Medicine, Emsey Hospital, Pendik, \u0130stanbul 34912, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0051-3951","authenticated-orcid":false,"given":"Fahri G\u00fcven","family":"\u00c7ak\u0131r","sequence":"additional","affiliation":[{"name":"Department of \u0130nternal Medicine, School of Medicine, Bursa Uluda\u011f University, G\u00f6r\u00fckle, Nil\u00fcfer, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7537-1699","authenticated-orcid":false,"given":"Birol","family":"Ocak","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Bursa Y\u00fcksek \u0130htisas Training and Research Hospital, Y\u0131ld\u0131r\u0131m, Bursa 16310, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7846-0870","authenticated-orcid":false,"given":"Ahmet Bilgehan","family":"\u015eahin","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Bursa Uluda\u011f University, G\u00f6r\u00fckle, Nil\u00fcfer, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2444-6587","authenticated-orcid":false,"given":"Alper","family":"Co\u015fkun","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Bursa Y\u00fcksek \u0130htisas Training and Research Hospital, Y\u0131ld\u0131r\u0131m, Bursa 16310, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8217-3471","authenticated-orcid":false,"given":"Sibel Oyucu","family":"Orhan","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, University of Health Sciences, Bursa City Education and Research Hospital, Bursa 16250, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2918-2592","authenticated-orcid":false,"given":"Arife","family":"Ula\u015f","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, University of Health Sciences, Bursa City Education and Research Hospital, Bursa 16250, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3931-0191","authenticated-orcid":false,"given":"Adem","family":"Delig\u00f6n\u00fcl","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Bursa Uluda\u011f University, G\u00f6r\u00fckle, Nil\u00fcfer, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9732-5340","authenticated-orcid":false,"given":"T\u00fcrkkan","family":"Evrensel","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Bursa Uluda\u011f University, G\u00f6r\u00fckle, Nil\u00fcfer, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0070-0889","authenticated-orcid":false,"given":"Erdem","family":"\u00c7ubuk\u00e7u","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Bursa Uluda\u011f University, G\u00f6r\u00fckle, Nil\u00fcfer, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,13]]},"reference":[{"key":"ref_1","unstructured":"International Agency for Research on Cancer (IARC) (2023, February 02). 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