Symptom‐to‐Diagnosis Interval, Treating‐Center Context, and Survival in Nasopharyngeal Carcinoma in Nonendemic Northern China: A Multicenter Real‐World Cohort Study

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ABSTRACT Background In nonendemic northern China, symptom recognition prompts diagnostic evaluation for nasopharyngeal carcinoma. Methods We analyzed 1022 patients with nonmetastatic nasopharyngeal carcinoma treated with definitive‐intent intensity‐modulated radiotherapy. The symptom‐to‐diagnosis interval extended from first symptom onset to pathological diagnosis. Logistic and Cox models assessed stage and survival; treating‐center analyses used a 2016–2022 common‐window cohort. Results Stages III–IVA disease occurred in 807 patients (79.0%), and 576 (56.4%) had intervals > 3 months. Intervals > 3 months were associated with Stages III–IVA disease (OR 2.52, 95% CI 1.85–3.45) and mortality (HR 1.62, 95% CI 1.28–2.06); after AJCC‐stage adjustment, HR 1.29 (95% CI 1.00–1.67). Treatment at participating tertiary general hospitals was associated with higher mortality (HR 1.46, 95% CI 1.07–1.98). Exploratory model‐standardized analyses yielded predicted 5‐year death differences of 25.99 (4.22–47.68) and 51.47 (26.27–75.50) for treating‐center and interval scenarios. Conclusions Longer intervals were associated with advanced stage and poorer survival; survival differed by treating‐center context.