Xu Y, et al. - Via performing this study, researchers sought to recognize factors linked with lymph node (LN) metastasis in nasopharyngeal carcinoma (NPC) patients. Further, they examined node distribution patterns, and investigated the prognostic value of the LN metastasis level for survival. From the Surveillance, Epidemiology, and End Results database, they included data of 2,994 patients with primary NPC diagnosed between 2006 and 2015. The analysis revealed the N0 stage in 695 patients and LN metastasis (classified as stage N1, N2, or N3) in 2,299 patients. LN metastasis was reported in 76.8%. Relative to younger patients, older patients exhibited a significantly worse 5-year overall survival (OS) and cancer-specific survival (CSS). In terms of histologic type, the lowest 5-year OS and CSS were reported for keratinizing squamous cell carcinoma, at 48.2% and 53.8%, respectively. The most common nodal involvement level was II (65.9%); this was followed by III (29.1%), V (25.6%), I (17.6%), IV (15.7%), and retropharynx (13.5%). The most common category was patients with only level II metastasis (classified as level 2). Taking level 2 as a reference, significantly higher risks for distant metastasis was observed in correlation to level 1 (patients with only level I), levels 2345 (patients with simultaneous levels II, III, IV, and V were classified as levels 2345), and levels 24 categories after adjustment for age, gender, and race. Levels 235 vs level 2 had a statistically significant HR of 1.708 for CSS following adjustment for age, gender, race, histology, TNM stage, and treatment.