Endoscopic surgery versus conservative treatment in nasopharyngeal carcinoma patients with nasopharyngeal necrosis

Background: Nasopharyngeal necrosis is a common sequela after treatment for nasopharyngeal carcinoma (NPC). This study aims to compare the effectiveness of the main interventions, endoscopic surgery and conservative therapy, on nasopharyngeal necrosis and identify potential beneficiaries. Methodology: This retrospective study was conducted on patients with nasopharyngeal necrosis from September 2008 to December 2020 at the Cancer Hospital of Sun Yat-sen University. The overall survival (OS) of patients with nasopharyngeal necrosis and their mucosal healing status were assessed. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to balance confounding factors between the two groups. Results: A total of 517 patients (124 females; 393 males) with nasopharyngeal necrosis were included in this analysis, among whom 287 received conservative therapy and 230 underwent endoscopic surgical treatment. In the unmatched cohort, the endoscopic surgery group had a higher 3-year OS rate than the conservative therapy group. Patients who underwent surgery had higher cure rates than did those who received conservative therapy. PSM and IPTW analyses yielded similar results. Multivariate analyses of the unmatched, PSM, and IPTW cohorts revealed that nasal endoscopic surgery was an independent protective factor for the OS of patients with nasopharyngeal necrosis. Conclusions: In this retrospective research, endoscopic surgery demonstrated better efficacy than conservative therapy for nasopharyngeal carcinoma patients with nasopharyngeal necrosis, while conservative therapy may be preferred for patients with superficial mucosal necrosis.