Pediatric nasopharyngeal carcinoma: Better prognosis and increased c‐Kit expression as compared to adults

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Abstract
Introduction Nasopharyngeal carcinoma (NPC) in children is distinguishable from the adult form by its close association with Epstein‐Barr virus (EBV) infection, a higher rate of undifferentiated histology, and a greater incidence of advanced locoregional disease. Patients and Methods Sixteen NPC patients, ≤20 years of age were identified from our 1976–2001 tumor registry records. Clinical stage, treatment, recurrence, and survival were evaluated. Sections were stained by immunohistochemistry for p53, Bcl‐2, Ki67, and c‐Kit and by in situ hybridization for EBER. Obtained data were compared to 32 adult patients. All patients had undifferentiated or non‐keratinizing NPC. Results EBER was positive in 100% of children, compared to 90% of adults. Comparing children to adults, median Ki67 index was 49% and 30%, p53 positive tumors were 69% and 94%, positive Bcl‐2 was 63% and 72%, and positive c‐Kit was 88% and 28%, respectively. Conclusion No parameter had significant predictive values for survival, although c‐Kit expression had a trend for better prognosis in the pediatric group. By univariate analysis of all 48 cases, positive c‐Kit was associated with better survival (P = 0.029), largely due to the better survival of the pediatric group. By multivariate analysis, increased stage (P = 0.006) and older age (P = 0.044) correlated with worse prognosis.

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