Zheng Shuohan, Liu Ya, He Zheng, He Shuiqing, Huang Zilu, Luo Wei, Han Fei, Tao Yalan, Chen Chunyan, Ouyang Puyun, Chen Lei, Huang Ying, Zhou Guanqun, Li Wenfei, Liu Qing, Chen Chen, Xia Yunfei
Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
Radiother Oncol. 2025 Sep;210:111051. doi: 10.1016/j.radonc.2025.111051. Epub 2025 Jul 19.
Current 8th AJCC stage is less effective in differentiating survival for nasopharyngeal carcinoma (NPC) in the intensity-modulated radiotherapy era. This study aims to evaluate the performance of CNG (Collaborative Nasopharyngeal Carcinoma Group) stage, a clinical downstaging of NPC based on the 7th AJCC stage, in predicting prognosis compared with the AJCC stage.
In this prospective observational study (ClinicalTrials.gov Identifier: NCT03529279), 1930 patients were restaged based on the 7th stage: CNG Stage I: Stage I, II, and III-nonT3N2; CNG Stage II: III-T3N2, IVA, and IVB; CNG Stage III: IVC. Kaplan-Meier method and the log-rank test were performed.
The 5-year overall survival (OS) of patients with CNG Stage I, II, and III was 97.0 %, 91.4 %, and 72.1 %, and survival curves of different stage groups were well-separated (all p < 0.001). The OS curves for 7th and 8th Stage I, II, and III almost overlapped. In patients with pre-treatment plasma EBV DNA > 0 and ≥ 1000 copies/ml, overall and inter-group OS differences were observed in CNG stage, while not shown in 7th and 8th stages. Among CNG Stage I, II, and III, the proportion of patients with EBV DNA = 0 was gradually decreasing (30.9 % vs 10.8 % vs 3.4 %), while the proportion of EBV DNA ≥ 1000 was gradually increasing (33.3 % vs 60.0 % vs 84.8 %, p < 0.001).
The CNG staging system presents a more accurate segregation of survival rates than the 7th and 8th editions, and it is well aligned with EBV DNA. Further studies of the staging system are warranted.
在调强放射治疗时代，当前的美国癌症联合委员会（AJCC）第8版分期在区分鼻咽癌（NPC）患者的生存率方面效果较差。本研究旨在评估基于第7版AJCC分期的鼻咽癌临床降期系统——CNG（鼻咽癌协作组）分期在预测预后方面与AJCC分期相比的表现。
在这项前瞻性观察研究（ClinicalTrials.gov标识符：NCT03529279）中，1930例患者根据第7版分期进行重新分期：CNG I期：I期、II期和III期非T3N2；CNG II期：III期T3N2、IVA期和IVB期；CNG III期：IVC期。采用Kaplan-Meier法和对数秩检验。
CNG I期、II期和III期患者的5年总生存率（OS）分别为97.0%、91.4%和72.1%，不同分期组的生存曲线分离良好（所有p<0.001）。第7版和第8版I期、II期和III期的OS曲线几乎重叠。在治疗前血浆EBV DNA>0且≥1000拷贝/ml的患者中，CNG分期观察到总体和组间OS差异，而在第7版和第8版分期中未显示。在CNG I期、II期和III期患者中，EBV DNA = 0的患者比例逐渐降低（30.9%对10.8%对3.4%），而EBV DNA≥1000的患者比例逐渐升高（33.3%对60.0%对84.8%，p<0.001）。
CNG分期系统在生存率区分方面比第7版和第8版更准确，且与EBV DNA情况良好匹配。有必要对该分期系统进行进一步研究。
