Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Int J Cancer. 2019 Apr 1;144(7):1713-1722. doi: 10.1002/ijc.31856. Epub 2018 Dec 24.
The eighth edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) stage classification (TNM) for nasopharyngeal carcinoma (NPC) was launched. It remains unknown if incorporation of nonanatomic factors into the stage classification would better predict survival. We prospectively recruited 518 patients with nonmetastatic NPC treated with radical intensity-modulated radiation therapy ± chemotherapy based on the eighth edition TNM. Recursive partitioning analysis (RPA) incorporating pretreatment plasma Epstein-Barr virus (EBV) DNA derived new stage groups. Multivariable analyses to calculate adjusted hazard ratios (AHRs) derived another set of stage groups. Five-year progression-free survival (PFS), overall survival (OS) and cancer-specific survival (CSS) were: Stage I (PFS 100%, OS 90%, CSS 100%), II (PFS 88%, OS 84%, CSS 95%), III (PFS 84%, OS 84%, CSS 90%) and IVA (PFS 71%, OS 75%, CSS 80%) (p < 0.001, p = 0.066 and p = 0.002, respectively). RPA derived four new stages: RPA-I (T1-T4 N0-N2 & EBV DNA <500 copies per mL; PFS 94%, OS 89%, CSS 96%), RPA-II (T1-T4 N0-N2 & EBV DNA ≥500 copies per mL; PFS 80%, OS 83%, CSS 89%), RPA-III (T1-T2 N3; PFS 64%, OS 83%, CSS 83%) and RPA-IVA (T3-T4 N3; PFS 63%, OS 60% and CSS 68%) (all with p < 0.001). AHR using covariate adjustment also yielded a valid classification (I: T1-T2 N0-N2; II: T3-T4 N0-N2 or T1-T2 N3 and III: T3-T4 N3) (all with p < 0.001). However, RPA stages better predicted survival for PS and CSS after bootstrapping replications. Our RPA-based stage groups revealed better survival prediction compared to the eighth edition TNM and the AHR stage groups.
第八版美国癌症联合委员会（AJCC）/国际癌症控制联盟（UICC）鼻咽癌（NPC）分期（TNM）已经发布。目前尚不清楚将非解剖因素纳入分期是否能更好地预测生存率。我们前瞻性地招募了 518 名接受根治性调强放疗±化疗的非转移性 NPC 患者，这些患者基于第八版 TNM 进行治疗。递归分区分析（RPA）结合治疗前血浆 EBV DNA 衍生出新的分期组。多变量分析计算调整后的危险比（AHR）得出了另一组分期组。五年无进展生存率（PFS）、总生存率（OS）和癌症特异性生存率（CSS）为：I 期（PFS 100%，OS 90%，CSS 100%）、II 期（PFS 88%，OS 84%，CSS 95%）、III 期（PFS 84%，OS 84%，CSS 90%）和 IVA 期（PFS 71%，OS 75%，CSS 80%）（p<0.001，p=0.066 和 p=0.002）。RPA 衍生出四个新的分期：RPA-I 期（T1-T4 N0-N2 和 EBV DNA<500 拷贝/毫升；PFS 94%，OS 89%，CSS 96%）、RPA-II 期（T1-T4 N0-N2 和 EBV DNA≥500 拷贝/毫升；PFS 80%，OS 83%，CSS 89%）、RPA-III 期（T1-T2 N3；PFS 64%，OS 83%，CSS 83%）和 RPA-IVA 期（T3-T4 N3；PFS 63%，OS 60%和 CSS 68%）（均为 p<0.001）。使用协变量调整的 AHR 也产生了有效的分类（I 期：T1-T2 N0-N2；II 期：T3-T4 N0-N2 或 T1-T2 N3 和 III 期：T3-T4 N3）（均为 p<0.001）。然而，在 bootstrap 复制后，RPA 分期对 PS 和 CSS 的生存预测更好。与第八版 TNM 和 AHR 分期相比，我们基于 RPA 的分期组能更好地预测生存率。
