Abstract
Background
The aim of this study was to identify the prognostic value and differences between the 6th and 7th International Union Against Cancer/American Joint Committee on Cancer staging systems in nasopharyngeal carcinoma.
Methods
The magnetic resonance imaging scans and medical records of 903 patients with histologically diagnosed non-disseminated nasopharyngeal carcinoma were reviewed retrospectively. Moreover, the extent of nasopharyngeal carcinoma was restaged according to the 6th and 7th editions of the staging systems.
Results
Among the 903 patients, the 5-year survival rates were as follows: overall survival (OS), 81 %; local relapse-free survival (LRFS), 90 %; distant metastasis-free survival, 86 %; and disease-free survival, 77 %. Using the 7th edition of the staging system, significant differences in OS between categories T1 and T3, categories T1 and T4, categories T2 and T3, and categories T2 and T4 were achieved (P < 0.001 for all models). However, LRFS differed only between categories T1 and T3 and categories T1 and T4 (P = 0.008 and P = 0.003). No statistically significant differences in LRFS were observed among the different groups of anatomic masticator space invasion (P = 0.781, P = 0.457 and P = 0.696). Significant differences in DMFS were achieved, except between categories N3a and N3b (P = 0.826). The T category and N category were independent prognostic factors for the major endpoints in the Cox multivariate regression analysis (P < 0.005).
Conclusion
The revisions of the 7th edition of the staging system are acceptable with regard to the distribution of patient classifications and the separation of survival curves. Moreover, this study will help to develop a better classification system and to better identify the appropriate treatment regimens in nasopharyngeal carcinoma.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Cheng SH, Yen KL et al (2001) Examining prognostic factors and patterns of failure in nasopharyngeal carcinoma following concomitant radiotherapy and chemotherapy: impact on future clinical trials. Int J Radiat Oncol Biol Phys 50(3):717–726
Chua DT, Sham JS et al (1997) Retropharygeal lymphadenopathy in patients with nasopharyngeal carcinoma: a computed tomography-based study. Cancer 79(5):869–877
Edge SB, Byrd DR et al (2010) AJCC cancer staging handbook from the AJCC cancer staging manual, 7th edn. Springer, New York, pp 63–79
Greene FL, Page DL et al (2002) AJCC cancer staging handbook from the AJCC cancer staging manual, 6th edn. Springer, New York, pp 47–60
Ho FCh, Tham IW et al (2012) Patterns of regional lymph node metastasis of nasopharyngeal carcinoma: a meta-analysis of clinical evidence. BMC Cancer 12:98
Lee N, Xia P et al (2002) Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys 53(1):12–22
Lee AW, Lau WH et al (2005a) Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma: NPC-9901 Trial by the Hong Kong Nasopharyngeal Cancer Study Group. J Clin Oncol 23(28):6675–6966
Lee AW, Sze WM et al (2005b) Treatment results for nasopharyngeal carcinoma in the modern era: the Hong Kong experience. Int J Radiat Oncol Biol Phys 61(4):1107–1116
Liao XB, Mao YP et al (2008) How does magnetic resonance imaging influence staging according to AJCC staging system for nasopharyngeal carcinoma compared with computed tomography? Int J Radiat Oncol Biol Phys 72(5):1368–1377
Lin JC, Jan JS et al (2003) Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression free survival. J Clin Oncol 21(4):631–637
Liu MT, Hsieh CY et al (2003) Prognostic factors affecting the outcome of nasopharyngeal carcinoma. Jpn J Clin Oncol 33(10):501–508
Liu MZ, Tang LL et al (2008) Evaluation of sixth edition of AJCC staging system for nasopharyngeal carcinoma and proposed improvement. Int J Radiat Oncol Biol Phys 70(4):1115–1123
Luo W, Deng XW et al (2004) Dosimetric evaluation for three dimensional conformal, conventional, and traditional radiotherapy plans for patients with early nasopharyngeal carcinoma (article in Chinese). Ai Zheng 23(5):605–608
Luo J, Chia KS et al (2007) Secular trends of nasopharyngeal carcinoma incidence in Singapore, Hong Kong and Los Angeles Chinese populations. Eur J Epidemiol 22(8):513–521
Ma J, Liu LZ et al (2007) Retropharyngeal lymph node in nasopharyngeal carcinoma: prognostic value and staging categories. Clin Cancer Res 13(5):1445–1452
Mao YP, Liang SB et al (2008) The N staging system in nasopharyngeal carcinoma with radiotherapy oncology group guidelines for lymph node level based on magnetic resonance imaging. Clin Cancer Res 14(22):7497–7503
Mao YP, Xie FY et al (2009) Re-evaluation of the 6th Edition of the AJCC staging system for nasopharyngeal carcinoma and proposed improvement based on magnetic resonance imaging. Int J Radiat Oncol Biol Phys 73(5):1326–1334
Ng WT, Lee AW et al (2007) N-staging by magnetic resonance imaging for patients with nasopharyngeal carcinoma: pattern of nodal involvement by radiological levels. Radiother Oncol 82(1):70–75
Perri F, Bosso D et al (2011) Locally advanced nasopharyngeal carcinoma: current and emerging treatment strategies. World J Clin Oncol 2(12):377–383
Sun Y, Ma J et al (2004) Regulation for distribution of metastatic cervical lymph node of 512 cases of nasopharyngeal carcinoma (article in Chinese). Ai Zheng 23(11 Suppl):1523–1527
Tang L, Li L et al (2008) Retropharyngeal lymph node metastasis in nasopharyngeal carcinoma detected by MRI: prognostic value and staging categories. Cancer 113(2):347–354
Tham IW, Hee SW et al (2009) Retropharyngeal nodal metastasis related to higher rate of distant metastasis in patients with N0 and N1 nasopharyngeal cancer. Head Neck 31(4):468–474
Wei WI, Sham JS (2005) Nasopharyngeal carcinoma. Lancet 365(9476):2041–2054
Zhao C, Han F et al (2004) Intensity modulated radiotherapy for local-regional advanced nasopharyngeal carcinoma (article in Chinese). Ai Zheng 23(11 Suppl):1532–1537
Acknowledgments
This work was supported by grants from the Medical Science Foundation of Guangdong Province (A2010188), National Natural Science Foundation of China (81101671), and the Research Funds for the Staff Studying Abroad of the Cancer Center, Sun Yat-sen University (303041217001).
Conflict of interest
No potential conflicts of interest were disclosed.
Author information
Authors and Affiliations
Corresponding authors
Additional information
Rui Sun and Hui-Zhi Qiu contributed equally.
Rights and permissions
About this article
Cite this article
Sun, R., Qiu, HZ., Mai, HQ. et al. Prognostic value and differences of the sixth and seventh editions of the UICC/AJCC staging systems in nasopharyngeal carcinoma. J Cancer Res Clin Oncol 139, 307–314 (2013). https://doi.org/10.1007/s00432-012-1333-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-012-1333-9