Staging of T2 and T3 nasopharyngeal carcinoma: Proposed modifications for improving the current AJCC staging system
Abstract Objectives We aimed to reconstitute T2 and T3 stage classification in nasopharyngeal carcinoma (NPC) cases and verify its utility in clinical settings. Materials and Methods We enrolled 792 NPC patients. Cox proportional hazards model was used to compare the effect sizes (hazard ratio [HR])...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-10-01
|
| Series: | Cancer Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cam4.3328 |
| _version_ | 1819225365382430720 |
|---|---|
| author | Chunyan Cui Haojiang Li Huali Ma Annan Dong Fei Xie Shaobo Liang Li Li Jian Zhou Chuanbo Xie Yue Yan Lizhi Liu |
| author_facet | Chunyan Cui Haojiang Li Huali Ma Annan Dong Fei Xie Shaobo Liang Li Li Jian Zhou Chuanbo Xie Yue Yan Lizhi Liu |
| author_sort | Chunyan Cui |
| collection | DOAJ |
| description | Abstract Objectives We aimed to reconstitute T2 and T3 stage classification in nasopharyngeal carcinoma (NPC) cases and verify its utility in clinical settings. Materials and Methods We enrolled 792 NPC patients. Cox proportional hazards model was used to compare the effect sizes (hazard ratio [HR]) of the cranial structure invasion on survival and select the structures for up‐staging or downstaging T2 and T3 NPC. The samples were reclassified and the survival curves for T2 and T3 stages were analyzed. The proposed new staging system was validated on an external sample (n = 433). Results Thirteen cranial structures were examined. American Joint Committee on Cancer (AJCC) T3 stage patients with the invasion of the base of the sphenoid (HR = 2.58, 95% CI = 1.16‐5.77) or base of the pterygoid (HR = 2.00, 95% CI = 0.84‐4.77) had significantly lower hazard ratios than T2 stage patients with the invasion of soft tissues in the bilateral parapharyngeal space (HR = 5.26, 95% CI = 2.02‐13.68) and single/bilateral carotid sheath (HR = 7.78, 95% CI = 3.06‐19.76). T3 stage with the invasion of the above‐mentioned bones was reclassified as T2, and T2 stage with the invasion of the above‐mentioned soft‐tissue structures was reclassified as T3. Survival analysis showed a significant difference between the reclassified T2 and T3 stages (P < 0.001). The results were replicated in the validation samples. Conclusion The proposed staging system for defining T2 and T3 stage NPC appears to be superior to the AJCC 8th edition. It could improve prognosis and optimize the treatment selection. |
| first_indexed | 2024-12-23T10:08:26Z |
| format | Article |
| id | doaj.art-c09c4f44bf9f4611886c3204e93d34ae |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-12-23T10:08:26Z |
| publishDate | 2020-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-c09c4f44bf9f4611886c3204e93d34ae2022-12-21T17:51:01ZengWileyCancer Medicine2045-76342020-10-019207572757910.1002/cam4.3328Staging of T2 and T3 nasopharyngeal carcinoma: Proposed modifications for improving the current AJCC staging systemChunyan Cui0Haojiang Li1Huali Ma2Annan Dong3Fei Xie4Shaobo Liang5Li Li6Jian Zhou7Chuanbo Xie8Yue Yan9Lizhi Liu10Department of Radiology Sun Yat‐Sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Guangzhou P. R. ChinaDepartment of Radiology Sun Yat‐Sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Guangzhou P. R. ChinaDepartment of Radiology Sun Yat‐Sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Guangzhou P. R. ChinaDepartment of Radiology Sun Yat‐Sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Guangzhou P. R. ChinaDepartment of Radiology Sun Yat‐Sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Guangzhou P. R. ChinaDepartment of Radiation Oncology Cancer CenterThe First People's Hospital of Foshan Affiliated to Sun Yat‐sen University Foshan P. R. ChinaDepartment of Radiology Sun Yat‐Sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Guangzhou P. R. ChinaDepartment of Radiology Sun Yat‐Sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Guangzhou P. R. ChinaCancer Prevention Center Sun Yat‐Sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Guangzhou P. R. ChinaCancer Prevention Center Sun Yat‐Sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Guangzhou P. R. ChinaDepartment of Radiology Sun Yat‐Sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Guangzhou P. R. ChinaAbstract Objectives We aimed to reconstitute T2 and T3 stage classification in nasopharyngeal carcinoma (NPC) cases and verify its utility in clinical settings. Materials and Methods We enrolled 792 NPC patients. Cox proportional hazards model was used to compare the effect sizes (hazard ratio [HR]) of the cranial structure invasion on survival and select the structures for up‐staging or downstaging T2 and T3 NPC. The samples were reclassified and the survival curves for T2 and T3 stages were analyzed. The proposed new staging system was validated on an external sample (n = 433). Results Thirteen cranial structures were examined. American Joint Committee on Cancer (AJCC) T3 stage patients with the invasion of the base of the sphenoid (HR = 2.58, 95% CI = 1.16‐5.77) or base of the pterygoid (HR = 2.00, 95% CI = 0.84‐4.77) had significantly lower hazard ratios than T2 stage patients with the invasion of soft tissues in the bilateral parapharyngeal space (HR = 5.26, 95% CI = 2.02‐13.68) and single/bilateral carotid sheath (HR = 7.78, 95% CI = 3.06‐19.76). T3 stage with the invasion of the above‐mentioned bones was reclassified as T2, and T2 stage with the invasion of the above‐mentioned soft‐tissue structures was reclassified as T3. Survival analysis showed a significant difference between the reclassified T2 and T3 stages (P < 0.001). The results were replicated in the validation samples. Conclusion The proposed staging system for defining T2 and T3 stage NPC appears to be superior to the AJCC 8th edition. It could improve prognosis and optimize the treatment selection.https://doi.org/10.1002/cam4.3328AJCC stage systemMRI imagingnasopharyngeal carcinomasurvival analysisT staging |
| spellingShingle | Chunyan Cui Haojiang Li Huali Ma Annan Dong Fei Xie Shaobo Liang Li Li Jian Zhou Chuanbo Xie Yue Yan Lizhi Liu Staging of T2 and T3 nasopharyngeal carcinoma: Proposed modifications for improving the current AJCC staging system Cancer Medicine AJCC stage system MRI imaging nasopharyngeal carcinoma survival analysis T staging |
| title | Staging of T2 and T3 nasopharyngeal carcinoma: Proposed modifications for improving the current AJCC staging system |
| title_full | Staging of T2 and T3 nasopharyngeal carcinoma: Proposed modifications for improving the current AJCC staging system |
| title_fullStr | Staging of T2 and T3 nasopharyngeal carcinoma: Proposed modifications for improving the current AJCC staging system |
| title_full_unstemmed | Staging of T2 and T3 nasopharyngeal carcinoma: Proposed modifications for improving the current AJCC staging system |
| title_short | Staging of T2 and T3 nasopharyngeal carcinoma: Proposed modifications for improving the current AJCC staging system |
| title_sort | staging of t2 and t3 nasopharyngeal carcinoma proposed modifications for improving the current ajcc staging system |
| topic | AJCC stage system MRI imaging nasopharyngeal carcinoma survival analysis T staging |
| url | https://doi.org/10.1002/cam4.3328 |
| work_keys_str_mv | AT chunyancui stagingoft2andt3nasopharyngealcarcinomaproposedmodificationsforimprovingthecurrentajccstagingsystem AT haojiangli stagingoft2andt3nasopharyngealcarcinomaproposedmodificationsforimprovingthecurrentajccstagingsystem AT hualima stagingoft2andt3nasopharyngealcarcinomaproposedmodificationsforimprovingthecurrentajccstagingsystem AT annandong stagingoft2andt3nasopharyngealcarcinomaproposedmodificationsforimprovingthecurrentajccstagingsystem AT feixie stagingoft2andt3nasopharyngealcarcinomaproposedmodificationsforimprovingthecurrentajccstagingsystem AT shaoboliang stagingoft2andt3nasopharyngealcarcinomaproposedmodificationsforimprovingthecurrentajccstagingsystem AT lili stagingoft2andt3nasopharyngealcarcinomaproposedmodificationsforimprovingthecurrentajccstagingsystem AT jianzhou stagingoft2andt3nasopharyngealcarcinomaproposedmodificationsforimprovingthecurrentajccstagingsystem AT chuanboxie stagingoft2andt3nasopharyngealcarcinomaproposedmodificationsforimprovingthecurrentajccstagingsystem AT yueyan stagingoft2andt3nasopharyngealcarcinomaproposedmodificationsforimprovingthecurrentajccstagingsystem AT lizhiliu stagingoft2andt3nasopharyngealcarcinomaproposedmodificationsforimprovingthecurrentajccstagingsystem |