Proposal for the 8th edition of the AJCC / UICC staging system for nasopharyngeal cancer in the era of intensity‐modulated radiotherapy

作者：Jian Ji Pan, Wai Tong Ng, Jing Feng Zong, Lucy L. K. Chan, Brian P O'Sullivan, Shao Jun Lin, Henry Chun‐Kin Sze, Yun Bin Chen, Cheuk‐Wai Choi, Qiao Juan Guo, Wai Kuen Kan, You Ping Xiao, Wei Xu, Quynh‐Thu Le, Christine M. Glastonbury, Alexander Dimitrios Colevas, Randal S. Weber, Jatin P. Shah, Anne W.M. Lee · 发表于：Cancer · 年份：2015 · DOI：10.1002/cncr.29795 · 被引用次数：373 · 研究领域：Head and Neck Cancer Studies、Head and Neck Surgical Oncology、Advanced Radiotherapy Techniques

BACKGROUND: An accurate staging system is crucial for cancer management. Evaluations for continual suitability and improvement are needed as staging and treatment methods evolve. METHODS: This was a retrospective study of 1609 patients with nasopharyngeal carcinoma investigated by magnetic resonance imaging, staged with the 7th edition of the American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) staging system, and irradiated by intensity-modulated radiotherapy at 2 centers in Hong Kong and mainland China. RESULTS: Among the patients without other T3/T4 involvement, there were no significant differences in overall survival (OS) between medial pterygoid muscle (MP) ± lateral pterygoid muscle (LP), prevertebral muscle, and parapharyngeal space involvement. Patients with extensive soft tissue involvement beyond the aforementioned structures had poor OS similar to that of patients with intracranial extension and/or cranial nerve palsy. Only 2% of the patients had lymph nodes > 6 cm above the supraclavicular fossa (SCF), and their outcomes resembled the outcomes of those with low extension. Replacing SCF with the lower neck (extension below the caudal border of the cricoid cartilage) did not affect the hazard distinction between different N categories. With the proposed T and N categories, there were no significant differences in outcome between T4N0-2 and T1-4N3 disease. CONCLUSIONS: After a review by AJCC/UICC preparatory committees, the changes rec...