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European Radiology

, Volume 30, Issue 2, pp 816–822 | Cite as

Nasopharyngeal carcinoma treated with intensity-modulated radiotherapy: clinical outcomes and patterns of failure among subsets of 8th AJCC stage IVa

  • Cheng-Long Huang
  • Rui Guo
  • Jun-Yan Li
  • Cheng Xu
  • Yan-Ping Mao
  • Li Tian
  • Ai-Hua Lin
  • Ying Sun
  • Jun Ma
  • Ling-long TangEmail author
Head and Neck
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Abstract

Objectives

The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for nasopharyngeal carcinoma (NPC) merged T4N0–2 and T1–4N3 to create stage IVa. In the present study, we aimed to assess the difference in clinical outcomes and patterns of failure between 8th AJCC T4N0–2 and T1–4N3 NPC patients treated with intensity-modulated radiotherapy (IMRT).

Methods

We included 3107 patients with stage IVa NPC disease (1871 with T4N0–2 and 1236 with T1–4N3) according to the 8th AJCC staging system. Overall survival (OS) was the primary endpoint. The clinical outcomes between T4N0–2 and T1–4N3 patients were compared.

Results

T1–4N3 patients had significantly worse 3-year OS (84.1% vs. 89.2%; p < 0.001) and distant metastasis–free survival (DMFS; 78.3% vs. 85.9%; p < 0.001), but better local relapse–free survival (LRFS; 94.9% vs. 92.2%; p = 0.003), as compared with T4N0–2 patients. Multivariate analysis showed that T1–4N3 was still an independent adverse prognostic factor for both DMFS (hazard ratio [HR] = 1.517, 95% confidence interval [CI] = 1.274–1.806, p < 0.001) and OS (HR = 1.315, 95% CI = 1.100–1.572, p = 0.003), whereas T4N0–2 was an independent adverse prognostic factor for LRFS (HR = 1.581, 95% CI = 1.158–2.158, p = 0.004).

Conclusions

In terms of the OS, T4N0–2 patients had better prognosis compared with T1–4N3 patients, and the patterns of failure differed between T4N0–2 and T1–4N3 patients. We believe that future modifications of the AJCC/UICC staging system should separate T4N0–2 from T1–4N3.

Key Points

• In nasopharyngeal carcinoma, T4N0–2 patients tended to develop local relapse, whereas T1–4N3 patients were more likely to develop distant metastasis.

• In terms of overall survival, T4N0–2 patients had better prognosis than T1–4N3 patients.

• T4N0–2 should be separated from T1–4N3 in the UICC/AJCC staging system.

Keywords

Prognosis Treatment failure Stage Nasopharyngeal carcinoma Intensity-modulated radiotherapy 

Abbreviations

18F-FDG

(18)F-fluorodeoxyglucose

AJCC/UICC

American Joint Committee on Cancer/Union for International Cancer Control

CI

Confidence interval

DMFS

Distant metastasis–free survival

EBV

Epstein-Barr virus

GTV

Gross tumor volume

HR

Hazard ratio

IMRT

Intensity-modulated radiotherapy

LRFS

Local relapse–free survival

MRI

Magnetic resonance imaging

NPC

Nasopharyngeal carcinoma

OS

Overall survival

PET/CT

Positron emission tomography CT

RRFS

Regional relapse–free survival

SPECT

Single photon emission computed tomography

Notes

Funding information

This work was supported by the Natural Science Foundation of China (grant number 81572962), the Natural Science Foundation of Guangdong Province (grant number 2017A030312003), the Health & Medical Collaborative Innovation Project of Guangzhou City, China (grant number 201803040003), the Innovation Team Development Plan of the Ministry of Education (grant number IRT_17R110), and the Overseas Expertise Introduction Project for Discipline Innovation (111 Project), (grant number B14035).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Ling-Long Tang from Sun Yat-sen University Cancer Center (Guangzhou, China).

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

One of the authors, Ai-Hua Lin, who is from the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University (Guangzhou, China), has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapyGuangzhouPeople’s Republic of China
  2. 2.Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapyGuangzhouPeople’s Republic of China
  3. 3.Department of Medical Statistics and Epidemiology, School of Public HealthSun Yat-sen UniversityGuangzhouPeople’s Republic of China

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