The development and external validation of simplified T category classification for nasopharyngeal carcinoma to improve the prognostic value in the intensity‐modulated radiotherapy era
Abstract Background Intensity‐modulated radiotherapy (IMRT) provides excellent local control in nasopharyngeal carcinoma (NPC). We investigated whether simplifying 8th American Joint Committee on Cancer staging system T categories improves prognostic value. Methods We used 2191 NPC patients as a tra...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-05-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.2131 |
| _version_ | 1797236871662665728 |
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| author | Ling‐Long Tang Shao‐Bo Liang Cheng‐Long Huang Fan Zhang Cheng Xu Yan‐Ping Mao Li Tian Ai‐Hua Lin Li Li Ying Sun Jun Ma |
| author_facet | Ling‐Long Tang Shao‐Bo Liang Cheng‐Long Huang Fan Zhang Cheng Xu Yan‐Ping Mao Li Tian Ai‐Hua Lin Li Li Ying Sun Jun Ma |
| author_sort | Ling‐Long Tang |
| collection | DOAJ |
| description | Abstract Background Intensity‐modulated radiotherapy (IMRT) provides excellent local control in nasopharyngeal carcinoma (NPC). We investigated whether simplifying 8th American Joint Committee on Cancer staging system T categories improves prognostic value. Methods We used 2191 NPC patients as a training set and 414 patients separately as an independent, external validation cohort. Results In the training set, local relapse‐free survival (LRFS), disease‐free survival (DFS), and overall survival (OS) were not significantly different between the 8th edition T2/T3 (P = 0.610, 0.380 and 0.353, respectively). Merging T2 and T3 to proposed T2 (proT2) provided significant differences in LRFS, DFS, and OS between proposed T categories. Proposed T categories had similar c‐indices for LRFS, DFS, and OS (vs the 8th edition), which was validated in the external cohorts. Moreover, for DFS, the adjusted HRs of the proT2N0 (3.8), proT1N1 (3.8), and proT2N1 (6.0) subsets were similar; the adjusted HRs of the proT3N0 (7.0), proT3N1 (11.4), proT1N2 (11.0), proT2N2 (11.6), and proT3N2 (13.3) subsets were similar; the adjusted HRs of the proT1N3 (17.8), proT2N3 (15.3), and proT3N3 (26.4) subsets were similar; the results of the adjusted HRs for OS had the same rule. Defining proT1N0 as stage I; proT1N1/proT2N0‐1 as stage II; proT3N0‐2/proT1‐2N2 as stage III; and proT1‐3N3 as stage IVa generated orderly, significant differences in DFS and OS between stages in the training set and external validation cohort. Conclusions In the IMRT era, three T categories are more reasonable (merging T2/T3 into T2) and proT3N0‐2 (the 8th edition T4N0‐2) should be down‐staged to stage III. |
| first_indexed | 2024-04-24T17:10:44Z |
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| id | doaj.art-936ef9139aa84bb2840ca692f4738dc5 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-04-24T17:10:44Z |
| publishDate | 2019-05-01 |
| publisher | Wiley |
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| series | Cancer Medicine |
| spelling | doaj.art-936ef9139aa84bb2840ca692f4738dc52024-03-28T10:30:36ZengWileyCancer Medicine2045-76342019-05-01852213222210.1002/cam4.2131The development and external validation of simplified T category classification for nasopharyngeal carcinoma to improve the prognostic value in the intensity‐modulated radiotherapy eraLing‐Long Tang0Shao‐Bo Liang1Cheng‐Long Huang2Fan Zhang3Cheng Xu4Yan‐Ping Mao5Li Tian6Ai‐Hua Lin7Li Li8Ying Sun9Jun Ma10Department of Radiation Oncology 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 Guangzhou People’s Republic of ChinaDepartment of Radiation Oncology 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 Guangzhou People’s Republic of ChinaDepartment of Radiation Oncology 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 Guangzhou People’s Republic of ChinaDepartment of Radiation Oncology 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 Guangzhou People’s Republic of ChinaDepartment of Radiation Oncology 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 Guangzhou People’s Republic of ChinaDepartment of Radiation Oncology 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 Guangzhou People’s Republic of ChinaImaging Diagnosis and Interventional Center State Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine Guangzhou People’s Republic of ChinaDepartment of Medical Statistics and Epidemiology School of Public Health, SunYat‐sen University Guangzhou People’s Republic of ChinaDepartment of Radiation oncology Cancer Center, First People’s Hospital of Foshan Affiliated to Sun Yat‐sen University Foshan People’s Republic of ChinaDepartment of Radiation Oncology 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 Guangzhou People’s Republic of ChinaDepartment of Radiation Oncology 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 Guangzhou People’s Republic of ChinaAbstract Background Intensity‐modulated radiotherapy (IMRT) provides excellent local control in nasopharyngeal carcinoma (NPC). We investigated whether simplifying 8th American Joint Committee on Cancer staging system T categories improves prognostic value. Methods We used 2191 NPC patients as a training set and 414 patients separately as an independent, external validation cohort. Results In the training set, local relapse‐free survival (LRFS), disease‐free survival (DFS), and overall survival (OS) were not significantly different between the 8th edition T2/T3 (P = 0.610, 0.380 and 0.353, respectively). Merging T2 and T3 to proposed T2 (proT2) provided significant differences in LRFS, DFS, and OS between proposed T categories. Proposed T categories had similar c‐indices for LRFS, DFS, and OS (vs the 8th edition), which was validated in the external cohorts. Moreover, for DFS, the adjusted HRs of the proT2N0 (3.8), proT1N1 (3.8), and proT2N1 (6.0) subsets were similar; the adjusted HRs of the proT3N0 (7.0), proT3N1 (11.4), proT1N2 (11.0), proT2N2 (11.6), and proT3N2 (13.3) subsets were similar; the adjusted HRs of the proT1N3 (17.8), proT2N3 (15.3), and proT3N3 (26.4) subsets were similar; the results of the adjusted HRs for OS had the same rule. Defining proT1N0 as stage I; proT1N1/proT2N0‐1 as stage II; proT3N0‐2/proT1‐2N2 as stage III; and proT1‐3N3 as stage IVa generated orderly, significant differences in DFS and OS between stages in the training set and external validation cohort. Conclusions In the IMRT era, three T categories are more reasonable (merging T2/T3 into T2) and proT3N0‐2 (the 8th edition T4N0‐2) should be down‐staged to stage III.https://doi.org/10.1002/cam4.2131external validationintensity‐modulated radiotherapynasopharyngeal carcinomaprognosisT category classification |
| spellingShingle | Ling‐Long Tang Shao‐Bo Liang Cheng‐Long Huang Fan Zhang Cheng Xu Yan‐Ping Mao Li Tian Ai‐Hua Lin Li Li Ying Sun Jun Ma The development and external validation of simplified T category classification for nasopharyngeal carcinoma to improve the prognostic value in the intensity‐modulated radiotherapy era Cancer Medicine external validation intensity‐modulated radiotherapy nasopharyngeal carcinoma prognosis T category classification |
| title | The development and external validation of simplified T category classification for nasopharyngeal carcinoma to improve the prognostic value in the intensity‐modulated radiotherapy era |
| title_full | The development and external validation of simplified T category classification for nasopharyngeal carcinoma to improve the prognostic value in the intensity‐modulated radiotherapy era |
| title_fullStr | The development and external validation of simplified T category classification for nasopharyngeal carcinoma to improve the prognostic value in the intensity‐modulated radiotherapy era |
| title_full_unstemmed | The development and external validation of simplified T category classification for nasopharyngeal carcinoma to improve the prognostic value in the intensity‐modulated radiotherapy era |
| title_short | The development and external validation of simplified T category classification for nasopharyngeal carcinoma to improve the prognostic value in the intensity‐modulated radiotherapy era |
| title_sort | development and external validation of simplified t category classification for nasopharyngeal carcinoma to improve the prognostic value in the intensity modulated radiotherapy era |
| topic | external validation intensity‐modulated radiotherapy nasopharyngeal carcinoma prognosis T category classification |
| url | https://doi.org/10.1002/cam4.2131 |
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