Kang Min, Long Jianxiong, Li Guisheng, Yan Haolin, Feng Guosheng, Liu Meilian, Zhu Jinxian, Wang Rensheng
Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P.R. China.
School of Public Health, Guangxi Medical University, Nanning, Guangxi, P.R. China.
Oncotarget. 2016 Mar 22;7(12):15252-61. doi: 10.18632/oncotarget.7553.
To establish a new clinical staging standard for nasopharyngeal carcinoma (NPC), based on intensity-modulated radiotherapy (IMRT), through a prospective multicenter clinical trial.
492 NPC patients were selected from six hospitals in the Guangxi Zhuang Autonomous Region, China from January 2006 to December 2009. Kaplan-Meier method was adopted to calculate survival rates. Log-rank test was used to compare survival differences.
According to the seventh edition of the UICC/AJCC staging system, the differences between T1, T2 and T3 are not statistically significant, suggesting that T1, T2 and T3 could be combined as new T1. There were significant differences between all N stages except those of N3a and N3b, suggesting that N3a and N3b could be combined as new N3. Additionally, the overall survival (OS) curves of stages I, II, III and IVa were not significantly different. Therefore, we propose a new clinical NPC staging standard based on magnetic resonance imaging (MRI) and IMRT as T stage (including T1 and T2) , N stage (including N0, N1, N2 and N3) and clinical staging includes I (T1N0M0), II (T1N1-2M0, T2N0M0), III (T2N1-2M0), IVa (TxN3M0) and IVb (TxNxM1). Recommended staging system performs better in risk difference and distribution balance . Furthermore, the differences in the 5-year curves of local relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and OS were all statistically more significant than the seventh edition of the UICC/AJCC staging system.
Proposed staging system is more adaptable to IMRT and predicts the prognosis of NPC patients more accurately.
通过一项前瞻性多中心临床试验，基于调强放射治疗（IMRT）建立一种新的鼻咽癌（NPC）临床分期标准。
2006年1月至2009年12月期间，从中国广西壮族自治区的六家医院选取了492例NPC患者。采用Kaplan-Meier法计算生存率。使用对数秩检验比较生存差异。
根据UICC/AJCC分期系统第七版，T1、T2和T3之间的差异无统计学意义，提示T1、T2和T3可合并为新的T1。除N3a和N3b外，所有N分期之间均存在显著差异，提示N3a和N3b可合并为新的N3。此外，I期、II期、III期和IVa期的总生存（OS）曲线无显著差异。因此，我们基于磁共振成像（MRI）和IMRT提出一种新的NPC临床分期标准，T分期（包括T1和T2）、N分期（包括N0、N1、N2和N3），临床分期包括I期（T1N0M0）、II期（T1N1 - 2M0，T2N0M0）、III期（T2N1 - 2M0）、IVa期（TxN3M0）和IVb期（TxNxM1）。推荐的分期系统在风险差异和分布平衡方面表现更好。此外，局部无复发生存（LRFS）、远处无转移生存（DMFS）和OS的5年曲线差异在统计学上均比UICC/AJCC分期系统第七版更显著。
提出的分期系统更适用于IMRT，能更准确地预测NPC患者的预后。
