Liu Meng-Zhong, Tang Ling-Long, Zong Jing-Feng, Huang Ying, Sun Ying, Mao Yan-Ping, Liu Li-Zhi, Lin Ai-Hua, Ma Jun
Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou, People's Republic of China.
Int J Radiat Oncol Biol Phys. 2008 Mar 15;70(4):1115-23. doi: 10.1016/j.ijrobp.2007.07.2353. Epub 2007 Nov 26.
To evaluate the 6th edition of the International Union Against Cancer/American Joint Committee on Cancer staging system for nasopharyngeal carcinoma and to search for ways to improve the system.
We performed a retrospective review of data from 749 biopsy-proven nonmetastatic nasopharyngeal carcinoma patients. All patients had undergone contrast-enhanced computed tomography and had received radiotherapy as their primary treatment.
The T stage, N stage, and stage group were significant, independent predictors for disease-specific death. No significant differences were found between Stage T2a and T1 in local failure-free survival or between Stage N3a and N2 in distant failure-free survival. Survival curves of the different T/N subsets showed a better segregation when T2a and N3a were downstaged to T1 and N2, respectively. The hazard ratio of disease-specific deaths for patients with T2N0 disease was similar to that of patients with T1N0 disease; the same result was found for the T3N0 and T4N0 subsets. Downstaging the T2N0 subset to Stage I, T3N0 to Stage II, and T4N0 to Stage III resulted in a more balanced patient distribution, better hazard consistency among subgroups, and improved hazard discrimination between overall stages.
Using the 6th edition of the American Joint Committee on Cancer staging system produced an acceptable distribution of patient numbers and segregation of survival curves among the different stage groups. The prognostic accuracy of the staging system could be improved by recategorization of the T, N, and group stage criteria.
评估国际抗癌联盟/美国癌症联合委员会第六版鼻咽癌分期系统，并探寻改进该系统的方法。
我们对749例经活检证实为非转移性鼻咽癌患者的数据进行了回顾性分析。所有患者均接受了增强计算机断层扫描，并以放射治疗作为主要治疗手段。
T分期、N分期和分期组是疾病特异性死亡的重要独立预测因素。在局部无瘤生存率方面，T2a期和T1期之间未发现显著差异；在远处无瘤生存率方面，N3a期和N2期之间也未发现显著差异。当T2a期和N3a期分别下调为T1期和N2期时，不同T/N亚组的生存曲线显示出更好的区分度。T2N0疾病患者的疾病特异性死亡风险比与T1N0疾病患者相似；T3N0和T4N0亚组也得到了相同的结果。将T2N0亚组下调为I期，T3N0下调为II期，T4N0下调为III期，可使患者分布更加均衡，亚组间风险一致性更好，总体分期之间的风险区分度提高。
采用美国癌症联合委员会第六版分期系统，不同分期组之间的患者数量分布和生存曲线区分度可接受。通过重新划分T、N和分期组标准，可提高分期系统的预后准确性。
