Kalogera-Fountzila Anna, Karanikolas Dimitrios, Katodritis Nikos, Samantas Epaminodas, Sarafopoulos Apostolos, Ikonomou Ippoliti, Zamboglou Nikolaos, Tselis Nikolaos, Dimitriadis Athanassios-Sokratis, Fountzilas George
Department of Radiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Strahlenther Onkol. 2006 Aug;182(8):458-66. doi: 10.1007/s00066-006-1538-4.
To compare the 4th edition 1992 and 6th edition 2002 of the American Joint Committee on Cancer (AJCC) staging systems, to evaluate the paranasopharyngeal structures and lymph node involvement, and to define the prognostic significance of the above factors to overall survival (OS) in patients with locally advanced nasopharyngeal carcinoma (NPC).
CT images of 162 patients, who were diagnosed with NPC and received irradiation alone or chemotherapy and irradiation, were retrospectively reviewed. CT scans, performed prior to and after the completion of treatment, were reviewed.
The parapharyngeal space was found to be involved very commonly (98%). 50 of 162 patients (31%) displayed parapharyngeal extension of the tumor to degree A, 59 patients (36%) showed degree B, and 50 patients (31%) degree C nasopharyngeal extension. According to the AJCC 6th edition 2002, patients were distributed into stages IIA, IIB, III, IVA, and IVB. By contrast, using the AJCC 4th edition 1992, patients were distributed into stages III and IV only. After a median follow up of 71.1 months, median survival was 60.7 months, with a 2-year survival rate of 71.3% and a 3-year survival rate of 62.2%. Multivariate analysis identified age, degree of parapharyngeal lateral extension, cavernous-sinus-infiltration, and size of infiltrated lymph nodes as independent prognostic factors for OS.
The 6th revision of TNM staging reported herein, provides a more uniform distribution of patients between stages. The degree of tumor extension into the parapharyngeal space should be considered in future TNM staging revisions.
比较美国癌症联合委员会（AJCC）1992年第4版和2002年第6版分期系统，评估鼻咽癌旁结构及淋巴结受累情况，并确定上述因素对局部晚期鼻咽癌（NPC）患者总生存（OS）的预后意义。
回顾性分析162例经诊断为NPC且接受单纯放疗或放化疗的患者的CT图像。对治疗前及治疗结束后的CT扫描结果进行分析。
发现咽旁间隙受累非常常见（98%）。162例患者中有50例（31%）肿瘤向咽旁间隙扩展至A度，59例（36%）为B度，50例（31%）为C度鼻咽癌扩展。根据2002年AJCC第6版，患者被分为IIA期、IIB期、III期、IVA期和IVB期。相比之下，采用1992年AJCC第4版时，患者仅被分为III期和IV期。中位随访71.1个月后，中位生存期为60.7个月，2年生存率为71.3%，3年生存率为62.2%。多因素分析确定年龄、咽旁外侧扩展程度、海绵窦浸润及受累淋巴结大小为OS的独立预后因素。
本文报道的TNM分期第6版在各期之间提供了更均匀的患者分布。未来TNM分期修订时应考虑肿瘤向咽旁间隙的扩展程度。
