Pan Jianji, Xu Yuanji, Qiu Sufang, Zong Jingfeng, Guo Qiaojuan, Zhang Yu, Lin Shaojun, Lu Jiade J
*Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China †Department of Radiation Oncology, National University Cancer Institute, National University Health System, National University of Singapore, Republic of Singapore.
Am J Clin Oncol. 2015 Apr;38(2):189-96. doi: 10.1097/COC.0b013e31828f5c96.
The Chinese 1992 staging system for nasopharyngeal carcinoma (NPC) was revised in 2008 and was renamed as the Chinese 2008 staging system. The seventh edition of the American Joint Committee on Cancer (AJCC) staging manual also defined new rules for classifying NPC in 2010. The purpose of the current study is to compare the 2 in terms of patient distribution and efficacy in predicting prognosis.
A total of 816 patients with untreated nondisseminated NPC who underwent magnetic resonance imaging scan of the nasopharynx and neck were studied retrospectively. All magnetic resonance imaging scans were reevaluated independently by 2 radiologists specialized in head and neck cancers. All patients were restaged according to the Chinese 2008 staging system and the AJCC staging system of NPC.
Using the 2 staging systems, the consistency for patient distributions in T, N, and overall stages was found to be moderate, with the κ value of 0.65, 0.54, and 0.46, respectively. According to the Chinese 2008 and the AJCC staging systems, the proportion of patients in stages I, II, III, and IV accounted for 2.3% versus 2.3%, 11.0% versus 23.7%, 39.4% versus 49.1%, and 47.3% versus 24.9%, respectively. The AJCC T classification was better in predicting the 5-year local relapse-free survival, whereas the Chinese 2008 N classification was superior in predicting the 5-year distant metastasis-free survival. However, survival curves for the 5-year overall survival were comparable in both systems.
We revealed a slightly better patient distribution of overall stage with AJCC comparing with the Chinese 2008 staging system. The prognostic value of AJCC T classification was considered to be better, whereas that of Chinese 2008 N classification was superior.
中国鼻咽癌（NPC）1992年分期系统于2008年进行了修订，并更名为中国2008年分期系统。美国癌症联合委员会（AJCC）分期手册第七版也于2010年为NPC分类定义了新规则。本研究的目的是比较两者在患者分布和预后预测效能方面的差异。
回顾性研究了816例未经治疗的非播散性NPC患者，这些患者均接受了鼻咽和颈部的磁共振成像扫描。所有磁共振成像扫描均由2名专门从事头颈癌诊断的放射科医生独立重新评估。所有患者均根据中国2008年分期系统和NPC的AJCC分期系统重新分期。
使用这两种分期系统，发现患者在T、N和总分期的分布一致性为中等，κ值分别为0.65、0.54和0.46。根据中国2008年和AJCC分期系统，I期、II期、III期和IV期患者的比例分别为2.3%对2.3%、11.0%对23.7%、39.4%对49.1%和47.3%对24.9%。AJCC的T分类在预测5年局部无复发生存率方面更好，而中国2008年的N分类在预测5年远处无转移生存率方面更优。然而，两种系统的5年总生存曲线具有可比性。
我们发现，与中国2008年分期系统相比，AJCC在总分期方面的患者分布稍好。AJCC的T分类的预后价值被认为更好，而中国2008年的N分类更优。
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