非鼻咽癌高发国家的鼻咽癌——新 NPC 分期系统的验证。

Nasopharyngeal carcinoma in a non-endemic country-Validation of the new NPC staging system.

机构信息

Centro Hospitalar Universitário do Porto - Otolaryngology-Head and Neck Surgery Department. Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Porto, Portugal.

Instituto Português de Oncologia do Porto Francisco Gentil - Otolaryngology-Head and Neck Surgery Department, Porto, Portugal.

出版信息

Acta Otorrinolaringol Esp (Engl Ed). 2023 Jan-Feb;74(1):39-49. doi: 10.1016/j.otoeng.2022.04.001.

DOI:10.1016/j.otoeng.2022.04.001

PMID:36858784

Abstract

BACKGROUND

Nasopharyngeal carcinoma (NPC) staging has recently been updated, with the eighth edition of the AJCC/UICC. In the last ten years, Intensity Modulated Radiotherapy (IMRT) has become a standard treatment for NPC. The authors aim to assess the benefits of the new AJCC staging system in predicting prognosis, as well as the improvement in survival outcomes in the IMRT era, in non-edemic population.

METHODS

Retrospective study selecting patients treated for NPC between January 2009 and December 2019 in a cancer treatment center in Portugal. Initial TNM staging (according to the seventh edition of the AJCC/UICC) was collected and each patient was restaged according to the new TNM staging system. Overall survival (OS) and Distant Metastasis Free Survival (DMFS) stratified by T and N classification and stage (according to the both TNM staging systems) were analyzed. Univariate and multivariate analysis was performed to evaluate which factors influence OS and DMFS. Data in this series was compared with a previous report from the same institution, before IMRT standard use.

RESULTS

113 patients were included, averaging 53.74 (±1.4) years old. With the new TNM staging, 5 patients were downstaged and 3 patients were upstaged. Over a median follow-up time of 41 months, the 5-year OS and DMFS were 77% and 79.8%, respectively. Neither the seventh nor the eighth editions of the AJCC/UICC staging system had good overall discrimination between each T classification OS and DMFS curves. Both the seventh and the eighth editions of the AJCC/UICC staging system had statistically significant overall discrimination between each N group and each stage group classification OS curves. Only N classification predicted OS in multivariate analysis. When comparing to a previous report from the same institution, OS has not improved majorly, especially in locoregionally advanced disease.

CONCLUSIONS

TNM staging still presents limitations in adequately predicting OS and DMFS.

摘要

背景

鼻咽癌（NPC）的分期最近已经更新，采用了第八版 AJCC/UICC。在过去的十年中，调强放疗（IMRT）已成为 NPC 的标准治疗方法。作者旨在评估新的 AJCC 分期系统在预测预后方面的益处，以及在非地方性人群中 IMRT 时代生存结果的改善。

方法

回顾性研究选择了 2009 年 1 月至 2019 年 12 月在葡萄牙一家癌症治疗中心接受 NPC 治疗的患者。收集了初始的 TNM 分期（根据 AJCC/UICC 的第七版），并根据新的 TNM 分期系统对每位患者进行重新分期。根据两种 TNM 分期系统对 T 和 N 分类和分期进行分层，分析总生存（OS）和远处转移无复发生存（DMFS）。进行单变量和多变量分析，以评估哪些因素影响 OS 和 DMFS。本系列数据与同一机构之前在 IMRT 标准使用前的报告进行了比较。

结果

共纳入 113 例患者，平均年龄为 53.74（±1.4）岁。根据新的 TNM 分期，有 5 例患者降期，3 例患者升期。在中位随访时间为 41 个月时，5 年 OS 和 DMFS 分别为 77%和 79.8%。第七版和第八版 AJCC/UICC 分期系统在每个 T 分类 OS 和 DMFS 曲线之间都没有很好的整体区分能力。第七版和第八版 AJCC/UICC 分期系统在每个 N 组和每个分期组的 OS 曲线之间均具有统计学显著的整体区分能力。只有 N 分类在多变量分析中预测 OS。与同一机构之前的报告相比，OS 并没有显著改善，尤其是在局部晚期疾病中。