Prognostic influence of invasion pattern and circumferential spread of internal carotid artery (ICA) on survival in patients with nasopharyngeal cancer (NPC) was not well established. Thus, we conducted a retrospective study to investigate the association with survival.

This was a retrospective study and included pathologically proved NPC patients from November 2015 to Dec 2022 at our Hospital. The invasion pattern and circumferential spread of ICA were carefully reviewed from computed tomogram or magnetic resonance image. Survival were estimated by the Kaplan-Meier method with five-year overall survival (OS) rate and five-year disease specific survival (DSS) rate.

A total of 200 NPC patients were included in this study for outcome analysis. Of the included patients, ICAI by NPC was observed in 55 (27.5%) patients. After stratifying by ICA invasion (ICAI) or not, the OS and DSS were 41% and 44% in patients with ICAI, while 81% and 85% in those without ICA invasion, respectively ( P < 0.001 in both OS and DSS). Subgroup analysis found that patients with C4 segment invasion had worst outcomes. The OS and DSS were 14% and 14% in patients with C4 segment invasion of ICA, while 72% and 77% in those without C4 segment invasion of ICA, respectively. As for extent of circumferential spread, the 5-year survival rate and 5-year disease specific survival rate were 80% versus 40% and 85% versus 45% for patients with spread less than 180 degree and more than 180 degree, respectively.

Locally advanced NPC patients with ICAI has miserable outcomes, especially those with ICAI more than 180 degree and C4 segment involvement. More aggressive interventions were needed to extend their survival.