Validation of the 8th Edition of the UICC/AJCC Staging System for Nasopharyngeal Carcinoma From Endemic Areas in the Intensity-Modulated Radiotherapy Era
Validation of the 8th Edition of the UICC/AJCC Staging System for Nasopharyngeal Carcinoma From Endemic Areas in the Intensity-Modulated Radiotherapy Era
复制标题
调强放射治疗时代流行地区鼻咽癌第 8 版 UICC/AJCC 分期系统的验证。
DOI：
10.6004/jnccn.2017.0121
复制
发表时间：
2017-07-01
影响因子：
13.4
通讯作者：
Ma, Jun
中科院分区：
文献类型：
--
作者：
Tang, Ling-Long;Chen, Yu-Pei;Ma, Jun
背景：在本研究中，我们评估了第8版国际癌症控制联盟(UICC)/AJCC鼻咽癌（NPC）分期系统，目的是验证其适用性，并为未来的改进提供进一步的信息。方法：回顾性分析1790例新诊断，非远处转移，组织学证实的鼻咽癌患者接受调强放疗（IMRT）治疗。采用赤池信息准则（Akaike information criterion， AIC）和Harrell’s concordance index （c-index）对不同分期系统的性能进行比较。结果：对于N（节点）类，根据第8版，不同组的生存曲线分离较好，预后模型对预后预测较好。与第7版相比，第8版的所有终点的AIC和c-index值都更高。然而，可能由于IMRT提供了更好的局部区域控制，T2和T3的生存曲线几乎重叠，局部区域无故障生存（P=.606）和无病生存（P=.735）无显著差异。由于T2和T3难以区分，第7版和第8版的T类AIC和c-index值相似。同样，在第8版和第7版中，II期和III期疾病的总生存和无病生存曲线也没有明确区分。结论：第8版UICC/AJCC鼻咽癌分期系统能够更准确地预测治疗结果。但是，在未来的版本中需要解决几个限制，进一步优化T类别分类是合理的。
Background: In this study, we evaluated the 8th edition of the Union for International Cancer Control (UICC)/AJCC staging system for nasopharyngeal carcinoma (NPC) in an endemic area, with the aim of validating its applicability and providing further information for future refinements. Methods: A total of 1,790 patients with newly diagnosed, non-distant metastatic, histologically proven NPC treated with intensity-modulated radiotherapy (IMRT) were retrospectively reviewed. The performance of various staging systems was compared using the Akaike information criterion (AIC) and Harrell's concordance index (c-index). Results: For N (node) category, the survival curves of different groups according to the 8th edition were well-separated, and the prognostic model predicted outcomes fairly well. The 8th edition had higher AIC and c-index values for all end points than the 7th edition. However, probably due to the improved locoregional control provided by IMRT, the survival curves for T2 and T3 almost overlapped, without significant differences in locoregional failure-free survival (P=.606) and disease-free survival (P=.735). Due to the difficultly of differentiating T2 and T3, the AIC and c-index values were similar for the T categories of the 7th and 8th editions. Similarly, the overall survival and disease-free survival curves for stage II and III disease were not clearly separated for either the 8th or 7th editions. Conclusions: The 8th edition of the UICC/AJCC staging system for NPC enables more accurate prediction of treatment outcomes. However, several limitations need to be addressed in future editions, and it would be reasonable to further optimize the T category classification.