Objective  To analyze survival and prognostic factors in patients with distant metastatic nasopharyngeal carcinoma in nonendemic areas.

  Methods  We retrospectively analyzed 91 patients who were newly diagnosed with distant metastatic nasopharyngeal carcinoma from June 2008 to December 2015. All patients received radical radiotherapy targeting the primary foci at a dose of 66-76.6 Gy (median dose 71 Gy). Eighty-seven patients received platinum-based chemotherapy (1-7 cycles), 4 patients did not receive chemotherapy, and 17 received concurrent targeted therapy (rituximab or cetuximab) during radiotherapy. Forty-nine patients completed the local treatment for metastatic foci during the initial treatment (48 patients were treated with radiotherapy and 1 patient with isolated lung metastasis was treated with surgery). Patients were followed up every 3 months post-treatment. The Kaplan-Meier method was used to calculate the survival rate, and a Cox regression model was used for multivariate analysis.

  Results  The median follow-up duration was 41 months. The 1-, 2-, and 3-year survival rates were 83.4%, 58.6%, and 43.3%, respectively, and the median survival time was 32 (6-87) months. The presence of metastases >3 (P=0.02) and the absence of local treatment for metastases (P=0.034) were independent factors for poor overall survival and prognosis.

  Conclusions  In patients with newly diagnosed distant metastatic nasopharyngeal carcinoma, radical radiotherapy (≥66 Gy) targeting the primary foci combined with local treatment of metastatic foci can improve the survival rate.