颅底侵犯亚分类在鼻咽癌中的价值：对预后分层和诱导化疗的影响。
Value of skull base invasion subclassification in nasopharyngeal carcinoma: implication for prognostic stratification and use of induction chemotherapy.
机构信息
Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China.
出版信息
Eur Radiol. 2022 Nov;32(11):7767-7777. doi: 10.1007/s00330-022-08864-7. Epub 2022 May 31.
OBJECTIVES
Prognoses for nasopharyngeal carcinoma (NPC) between categories T2 and T3 in the Eighth American Joint Committee on Cancer (AJCC) staging system were overlapped. We explored the value of skull base invasion (SBI) subclassification in prognostic stratification and use of induction chemotherapy (IC) to optimize T2/T3 categorization for NPC patients.
METHODS
We retrospectively reviewed 1752 NPC patients from two hospitals. Eight skull base bone structures were evaluated. Survival differences were compared between slight SBI (T3 patients with pterygoid process and/or base of the sphenoid bone invasion only) and severe SBI (T3 patients with other SBIs) with or without IC using random matched-pair analysis. We calculated the prognosis and Harrel concordance index (C-index) for the revised T category and compared IC outcomes for the revised tumor stages.
RESULTS
Compared to severe SBI, slight SBI showed better 5-year overall survival (OS) (81.5% vs. 92.3%, p = 0.001) and progression-free survival (PFS) (71.5% vs. 83.0%, p = 0.002). Additional IC therapy did not significantly improve OS and PFS in slight SBI. The proposed T category separated OS, PFS, and locoregional recurrence-free survival in T2 and T3 categories with statistical significance. An improved C-index for OS prediction was observed in the proposed T category with combined confounding factors, compared to the AJCC T staging system (0.725 vs. 0.713, p = 0.046). The survival benefits of IC were more obvious in the advanced stage.
CONCLUSIONS
NPC patients with slight SBI were recommended to downstage to T2 category. The adjustment for T category enabled better prognostic stratification and guidance for IC use.
KEY POINTS
• For nasopharyngeal carcinoma (NPC) patients in T3 category, slight skull base invasion was a significant positive predictor for OS and PFS. • NPC patients with slight SBI might not gain significant survival benefits from induction chemotherapy. • Downstaging slight SBI NPC patients to T2 category would make a more accurate risk stratification, improve the predicting performance in OS, and have a better guidance in the use of IC for patients in advanced stage.
目的
第八版美国癌症联合委员会（AJCC）分期系统中 T2 和 T3 类别的鼻咽癌（NPC）预后重叠。我们探讨了颅底侵犯（SBI）亚分类在预后分层中的价值，以及诱导化疗（IC）在优化 NPC 患者 T2/T3 分类中的作用。
方法
我们回顾性分析了来自两家医院的 1752 例 NPC 患者。评估了 8 个颅底骨结构。采用随机配对分析比较了 SBI 轻微（仅翼突和/或蝶骨底部侵犯的 T3 患者）和 SBI 严重（T3 患者有其他 SBI）患者有无 IC 治疗的生存差异。我们计算了修订后的 T 分期的预后和 Harrell 一致性指数（C 指数），并比较了修订后的肿瘤分期的 IC 结果。
结果
与 SBI 严重组相比，SBI 轻微组患者 5 年总生存率（OS）（81.5% vs. 92.3%，p = 0.001）和无进展生存率（PFS）（71.5% vs. 83.0%，p = 0.002）更好。SBI 轻微患者中，额外的 IC 治疗并不能显著提高 OS 和 PFS。提出的 T 分期方案将 T2 和 T3 类别中的 OS、PFS 和局部区域无复发生存率进行了统计学分离。与 AJCC T 分期系统相比，在考虑了混杂因素后，提出的 T 分期方案对 OS 预测的 C 指数有显著提高（0.725 vs. 0.713，p = 0.046）。IC 的生存获益在晚期更为明显。
结论
SBI 轻微的 NPC 患者建议降期为 T2 期。T 分期的调整可实现更好的预后分层和 IC 使用指导。
关键点
对于 T3 类别的鼻咽癌（NPC）患者，颅底轻微侵犯是 OS 和 PFS 的显著正预测因子。
SBI 轻微的 NPC 患者可能无法从诱导化疗中获得显著的生存获益。
将 SBI 轻微的 NPC 患者降期为 T2 期可实现更准确的风险分层，提高 OS 预测性能，并为晚期患者的 IC 使用提供更好的指导。
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