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World J Clin Oncol. Aug 24, 2026; 17(8): 124227
Published online Aug 24, 2026. doi: 10.5306/wjco.124227
Timing matters: Early vs late recurrence in nasopharyngeal carcinoma and its impact on survival
Jing-Bo Wang, Yang Meng, Mei-Lin He, Si-Jia Zhang, Xiao-Dong Huang, Ye Zhang, Run-Ye Wu, Kai Wang, Xue-Song Chen, Yuan Qu, Jiang-Hu Zhang, Qing-Feng Liu, Jing-Wei Luo, Li Gao, Jian-Ping Xiao, Ye-Xiong Li, Li-Hua Luo, Jun-Lin Yi
Jing-Bo Wang, Yang Meng, Mei-Lin He, Xiao-Dong Huang, Ye Zhang, Run-Ye Wu, Kai Wang, Xue-Song Chen, Yuan Qu, Jiang-Hu Zhang, Qing-Feng Liu, Jing-Wei Luo, Li Gao, Jian-Ping Xiao, Ye-Xiong Li, Jun-Lin Yi, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Jing-Bo Wang, Department of Oncology, The First Hospital of Qiqihar, Qiqihar 161005, Heilongjiang Province, China
Si-Jia Zhang, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Li-Hua Luo, Department of Oncology, Central Hospital of Enshi Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi 445000, Hubei Province, China
Co-first authors: Jing-Bo Wang and Yang Meng.
Co-corresponding authors: Li-Hua Luo and Jun-Lin Yi.
Author contributions: Wang JB, Meng Y, Luo LH and Yi JL designed the research study; He ML, Zhang SJ, Huang XD, Zhang Y, Wu RY, Wang K, Chen XS, Qu Y, Zhang JH, Liu QF, Luo JW and Xiao JP performed the research and collected the clinical data; Wang JB, Meng Y and He ML analyzed the data and performed statistical analysis; Wang JB and Meng Y drafted the manuscript; Li YX, Luo LH and Yi JL critically revised the manuscript and supervised the study. All authors have read and agreed to the published version of the manuscript. Wang JB and Meng Y contributed equally to this work. We designated Yi JL and Luo LH as co-corresponding authors to accurately reflect their joint leadership in executing this study. Although the analyzed patient cohort originated exclusively from the National Cancer Center, Luo LH participated in an extended period of intensive on-site collaboration within our primary research group. During this time, both senior authors jointly managed the research workflow, maintaining strict quality control over clinical data curation, methodological implementation, and manuscript development. Their combined oversight and shared administrative efforts were vital for ensuring the scientific rigor of this investigation. Therefore, shared corresponding authorship correctly acknowledges their equal accountability for overseeing the research process, addressing potential inquiries, and guaranteeing the overall integrity of the published manuscript.
AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Supported by Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences, No. 2024-I2M-C&T-B-063 and No. 2024-I2M-C&T-A-006; Beijing Hope Run Special Fund of Cancer Foundation of China, No. LC2021 L06; National Natural Science Foundation of China, No. 81172125; and National Key Research and Development Program of China, No. 2023YFC2411602.
Institutional review board statement: This research was conducted in accordance with the principles outlined in the Declaration of Helsinki and obtained ethical approval from the Ethics Committee of our institution (NCC: 23/353-4095).
Informed consent statement: Given its observational nature using retrospective clinical data, informed consent was waived.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Corresponding author: Jun-Lin Yi, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China.
yijunlin1969@163.com
Received: June 15, 2026
Revised: July 27, 2026
Accepted: August 20, 2026
Published online: August 24, 2026
Processing time: 72 Days and 1.5 Hours
BACKGROUND
Despite the wide utilization of intensity-modulated radiation therapy and other advanced treatment modalities, approximately 10% of patients with nasopharyngeal carcinoma (NPC) still suffer from local or regional disease recurrence, leading to deteriorated survival outcome. Particularly, early recurrence is often associated with more aggressive biological behavior and greater resistance to initial treatments, subsequently resulting in poorer survival outcomes.
AIM
To investigate the temporal distribution of site-specific recurrence and evaluate the prognostic impact of early vs late recurrence in NPC.
METHODS
This study retrospectively included 330 recurrent NPC patients who received initial treatment of radical radiotherapy from January 1990 to December 2020 in our center. Patients were categorized into early and late recurrence groups using the maximally selected rank method. Post-recurrence overall survival (OS) was evaluated utilizing Kaplan-Meier estimates and multivariable Cox regression analysis.
RESULTS
Among the 330 eligible patients, 167 developed pure local recurrence, 86 had pure regional recurrence, and 77 had locoregional recurrence. With a median follow-up duration of 97.8 months, there was no significant difference in timing distribution across various patterns of failure. The peak incidence of progression was observed in the 2nd year, contributing 29.4% of all progression events, with a cumulative 5-year proportion of 82.8%. The optimal cutoff for differentiating early and late recurrence was identified as 24 months. Advanced T (P = 0.008) and N (P = 0.028) stages were predisposing factors for early recurrence. Survival analysis manifested that late locoregional recurrence was associated with markedly better post-recurrence OS [hazard ratio (HR) = 0.37, P = 0.006], whereas such scenario was not observed in entire cohort or sub-cohorts with pure local or regional failure. The complementary 24-month landmark analysis further unveiled that late recurrence was associated with superior post-landmark OS across the entire cohort (HR = 0.38, P < 0.001) and all failure subgroups.
CONCLUSION
Recurrence timing is a pivotal prognostic factor in recurrent NPC. Early locoregional recurrence within 24 months is indicative of significantly inferior post-recurrence OS, warranting more intensive surveillance and aggressive salvage strategies for this subset.
Core Tip: This is the core tip of our study focusing on recurrent nasopharyngeal carcinoma. In 330 recurrent patients, recurrence events peaked in the second year. Recurrence timing is a pivotal prognostic factor. Early locoregional recurrence within 24 months is indicative of significantly inferior post-recurrence overall survival, warranting more intensive surveillance and aggressive salvage strategies for this subset.
