Ophthalmic manifestations of nasopharyngeal carcinoma (NPC): A systematic review of reported cases with and without prior history of nasopharyngeal carcinoma

Alkatan, Hind Manaa; Alrashed, Saleh Hamad; Maktabi, Azza MY

doi:10.5935/0004-2749.2022-0241

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ORIGINAL ARTICLE • Arq. Bras. Oftalmol. 87 (2) • 2024 • https://doi.org/10.5935/0004-2749.2022-0241 copy

Ophthalmic manifestations of nasopharyngeal carcinoma (NPC): A systematic review of reported cases with and without prior history of nasopharyngeal carcinoma

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

We aimed to study reported cases of nasopharyngeal carcinoma presenting with ophthalmic manifestations with and without a prior diagnosis of nasopharyngeal carcinoma.

Methods:

We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A literature search was conducted using the MEDLINE database in PubMed and Google Scholar. We included patients with a previous diagnosis of nasopharyngeal carcinoma in Group I and those without a prior diagnosis of nasopharyngeal carcinoma in Group II. Data included demographics, clinical presentation, history of nasopharyngeal carcinoma, treatment, histopathological description, World Health Organization classification, and outcome.

Results:

Fifty-eight patients (26 in Group I and 32 in Group II) were included. The male-to-female ratio was 3:1. The mean age of the patients (53.3 ± 11.7 years and 54.8 ± 16.2 years, respectively) and gender did not differ significantly between the two groups. The most common ocular presentations were diplopia and proptosis in the first group (each in 34.6%), whereas visual disturbance was most common in the second group (46.9%). Treatment options and World Health Organization grading were comparable. The outcome in 38 patients (after a comparable follow-up period) was significantly better in group II (p=0.003). There was no statistically significant difference in the outcome of 23 patients in correlation with World Health Organization grades II versus III irrespective of group (p=0.094).

Conclusions:

The demographics of patients with nasopharyngeal carcinoma presenting with ophthalmic manifestations were similar between the two study groups, with a wide age range and male predominance. Patients presenting initially to ophthalmologists with no history of nasopharyngeal carcinoma have a more favorable outcome. World Health Organization grading may have less value as a prognostic indicator.

Keywords:
Nasopharyngeal carcinoma; Carcinoma; Eye manifestations; Exophthalmos; Diplopia; Systematic review

Characteristic	Group I: With history of diagnosed NPC (n=26)	Group II: Without history of NPC (n=32)	p-value
Age
Age in years - all, mean ±SD [ Range]	53.3 ± 11.7 [22-74]	54.8 ± 16.2 [27-92]	0.699
Age in years men, mean ±SD [ Range]	54.1 ± 11.4 [22-70]	54.3 ± 16.2 [27-92]	0.948
Age in years women, mean ±SD [ Range]	50.8 ± 13.2 [37-74]	56.1 ± 17.1 [30-78]	0.542
Gender
Male (n=44)	20 (76.9)	24 (75.0)	0.865
Female (n=14)	6 (23.1)	8 (25.0)	0.865
Clinical Presentation
Visual Disturbance	6 (23.1)	15 (46.9)	0.063
Orbital Pain	3 (11.5)	4 (12.5)	0.908
Diplopia	9 (34.6)	6 (18.8)	0.176
Eyelid swelling/Mass	5 (19.2)	4 (12.5)	0.487
Proptosis	9 (34.6)	8 (25.0)	0.428
Ptosis	2 (7.7)	5 (15.6)	0.362
Horner	1 (3.8)	3 (9.4)	0.406
Optic Disc swelling/pallor	0 (0.0)	4 (12.5)	0.064

Characteristic	Group I: With history of diagnosed NPC (n=26)	Group II: Without history of NPC (n=32)	p-value
Treatment
Chemotherapy (n=35)	18 (69.2)	17 (53.1)	0.212
Radiotherapy (n=44)	22 (84.6)	22 (68.8)	0.160
Chemotherapy and radiotherapy (n=30)	16 (61.5)	14 (43.8)	0.178
Orbitotomy (n=5)	3 (11.5)	2 (6.2)	0.475
Follow-up in months, mean ±SD [ Range]	24.1 ± 17.2 [2-64]	26.9 ± 38.8 [1-180]	0.786
Outcome (n=38) ^† † Note that the outcome was compared between the two groups in a total of 38 patients (17 in group I and 21 in group II).
Alive (n=22)	5 (29.4)	17 (81.0)	0.003^* * Statistically significant at the 5% level of significance.
Dead (n=16)	12 (70.6)	4 (19.0)	0.908

Characteristic	Group I: With history of diagnosed NPC (n=9)	Group II: Without history of NPC (n=26)	p-value
WHO Grading
WHO I	1^† † This case was excluded from further analysis in table 4 because of the low number of patients in group WHO I. (11.1)	0 (0.0)	0.091
WHO II	3 (33.3)	11 (42.3)	0.640
WHO III	5 (55.6)	15 (57.7)	0.914

WHO Grading	Outcome		p-value
WHO Grading	Alive (n=14)	Dead (n=9)	p-value
WHO II (n=8)	3 (37.5)	5 (62.5)	0.094
WHO III (n=15)	11 (73.3)	4 (26.7)

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[1] Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.