ArticleTherapeutic advances in medical oncology2026
Dynamic disease progression in non-metastatic nasopharyngeal carcinoma post-radical radiotherapy: a Markov model-based analysis in a Chinese cohort.
Article in Therapeutic advances in medical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The evolution of nasopharyngeal carcinoma (NPC) involves potential transitions among states of recurrence, metastasis, and/or remission. Understanding the dynamics of NPC progression following radical radiotherapy may help optimize surveillance protocols and patient management. Objectives: To characterize the progression dynamics of NPC following radical radiotherapy. Design: A retrospective study. Methods: The cohort comprised NPC patients who underwent radical intensity-modulated radiotherapy between 2016 and 2022. A multi-state Markov model was employed to estimate transition intensities and probabilities across various disease states, including failure-free, single failure event (recurrence or metastasis, R/M), multi-event progression (recurrence and metastasis, R&M), and death. A Shiny-based web tool was developed to facilitate the clinical translation of the model. Results: A total of 4800 NPC patients were included, yielding 18,641 disease-state assessments, with a median follow-up of 3.3 years. The transition intensity from metastasis to death (0.025, 95% confidence interval (CI), 0.021-0.029) was 2.3 times greater than that from recurrence to death (0.011, 95% CI, 0.009-0.014). The estimated probabilities of remaining failure-free, experiencing R/M, and deteriorating to death were 89.9%, 7.7%, and 2.1% at 2 years, respectively. Among patients with recurrence, the probabilities of progression to metastasis and death were 3.8% and 24.5%; among those with metastasis, the probabilities of progression to recurrence and death were 2.1% and 45.0%, respectively. Increasing age, male sex, advanced TNM stage, higher pre-treatment Epstein-Barr virus (EBV) DNA, and detectable post-treatment EBV DNA were associated with treatment failure. A web tool was developed to predict NPC disease-state transitions at 2 years. Conclusion: These findings provide initial evidence on the dynamic progression of NPC, which may inform clinical management and patient counseling. Risk-stratified screening and targeted interventions could help mitigate disease progression.
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