(175) Endoscopic Surgery vs. Conservative Treatment for Nasopharyngeal Necrosis in NPC

Introduction: Nasopharyngeal necrosis is a common sequela of treatment for nasopharyngeal carcinoma, especially in recurrent cases. Nasal endoscopic surgery and conservative therapy are the main treatments for nasopharyngeal necrosis, but there is no study directly comparing their efficacy. This retrospective study aims to compare the effect of endoscopic surgery and conservative therapy on the treatment of nasopharyngeal necrosis and to identify the potential beneficiaries for each treatment.

Methods: 517 NPC patients with nasopharyngeal necrosis between 2008 and 2020 were included in this study, of whom 287 received conservative therapy and 230 received nasal endoscopic surgery. The primary endpoint was overall survival. Propensity score matching and inverse probability of treatment weighting were used to balance confounding factors between both groups. The COX proportional hazard model was used to identify independent prognostic factors for nasopharyngeal necrosis. Subgroup analysis was performed to determine the effectiveness of endoscopic surgery and conservative therapy in subsets.

Results: In the unmatched cohort, the 3-year overall survival was 35.0% (95%CI, 29.3-41.8%) in the conservative therapy group versus 70.5% (95%CI, 64.5-77.1%) in the endoscopic surgery group. Patients in surgery group had higher cure rates (73.0%, 95%CI 67.0-78.4%) than those in conservative therapy group (33.1%, 95%CI 27.9-38.7%). PSM and IPTW analyses yielded similar results. Multivariate analyses in all three cohorts showed that nasal endoscopic surgery was an independent protective factor in OS of nasopharyngeal necrosis patient. The benefit of endoscopic surgery was consistent across all subgroups except for patients with superficial mucosal necrosis.

Conclusions: This study shows that treatment with endoscopic surgery yields better efficacy than conservative therapy for NPC patients with nasopharyngeal necrosis. Conservative therapy may be preferred for patients with superficial mucosal necrosis.