Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou 510060, Guangdong, China.
Br J Cancer. 2013 Dec 10;109(12):2987-97. doi: 10.1038/bjc.2013.659. Epub 2013 Oct 22.
There are few systematic evaluations regarding the sixth and seventh editions of the UICC/AJCC TNM Staging System (TNM6th, TNM7th) and Chinese 2008 Staging System (TNMc2008) for nasopharyngeal carcinoma (NPC).
We classified 2333 patients into intensity-modulated radiotherapy (IMRT) cohort (n=941) and conventional radiotherapy (CRT) cohort (n=1392). Tumour staging defined by TNM6th, TNM7th and TNMc2008 was compared based on Akaike information criterion (AIC) and Harrell's concordance index (c-index).
For T-classification, TNM6th (AIC=2585.367; c-index=0.6390385) had superior prognostic value to TNM7th (AIC=2593.242; c-index=0.6226889) and TNMc2008 (AIC=2593.998; c-index=0.6237146) in the IMRT cohort, whereas TNMc2008 was superior (AIC=5999.054; c-index=0.623547) in the CRT cohort. For N-classification, TNMc2008 had the highest prognostic value in both cohorts (AIC=2577.726, c-index=0.6297874; AIC=5956.339, c-index=0.6533576). Similar results were obtained when patients were stratified by chemotherapy types, age and gender. Using staging models in the IMRT cohort, we failed to identify better stage migrations than TNM6th T-classification and TNMc2008 N-classification. We therefore proposed to combine these categories; resultantly, stage groups of the proposed staging system showed superior prognostic value over TNM6th, TNM7th and TNMc2008.
TNM6th T-classification and TNMc2008 N-classification have superior prognostic value in the IMRT era. By combining them with slight modifications, TNM criteria can be unified and its prognostic value be improved.
针对鼻咽癌，UICC/AJCC TNM 分期系统（TNM6th、TNM7th）和中国 2008 分期系统（TNMc2008）的第六版和第七版系统评价较少。
我们将 2333 例患者分为调强放疗（IMRT）队列（n=941）和常规放疗（CRT）队列（n=1392）。根据 Akaike 信息准则（AIC）和 Harrell 一致性指数（c-index）比较基于 TNM6th、TNM7th 和 TNMc2008 的肿瘤分期。
对于 T 分期，TNM6th（AIC=2585.367；c-index=0.6390385）在 IMRT 队列中的预后价值优于 TNM7th（AIC=2593.242；c-index=0.6226889）和 TNMc2008（AIC=2593.998；c-index=0.6237146），而在 CRT 队列中，TNMc2008（AIC=5999.054；c-index=0.623547）则具有优势。对于 N 分期，TNMc2008 在两个队列中均具有最高的预后价值（AIC=2577.726，c-index=0.6297874；AIC=5956.339，c-index=0.6533576）。当按化疗类型、年龄和性别对患者进行分层时，也得到了类似的结果。在 IMRT 队列中使用分期模型，我们未能发现优于 TNM6th T 分期和 TNMc2008 N 分期的更好的分期迁移。因此，我们建议将这些类别结合起来；结果表明，所提出的分期系统的分期组优于 TNM6th、TNM7th 和 TNMc2008。
在调强放疗时代，TNM6th T 分期和 TNMc2008 N 分期具有更高的预后价值。通过对其进行轻微修改并将它们结合起来，可以统一 TNM 标准并提高其预后价值。
