A new staging system for nasopharyngeal carcinoma based on intensity-modulated radiation therapy: results of a prospective multicentric clinical study.
A new staging system for nasopharyngeal carcinoma based on intensity-modulated radiation therapy: results of a prospective multicentric clinical study.
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基于调强放射治疗的鼻咽癌新分期系统：前瞻性多中心临床研究的结果。
DOI：
10.18632/oncotarget.7553
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发表时间：
2016-03-22
期刊：
影响因子：
--
通讯作者：
Wang R
中科院分区：
文献类型：
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作者：
Kang M;Long J;Li G;Yan H;Feng G;Liu M;Zhu J;Wang R
通过前瞻性多中心临床试验，建立基于调强放疗（IMRT）的鼻咽癌（NPC）临床分期新标准。选取2006年1月至2009年12月广西6家医院的492例鼻咽癌患者。采用Kaplan-Meier法计算生存率。采用Log-rank检验比较生存差异。根据第七版UICC/AJCC分期系统，T1、T2和T3之间的差异无统计学意义，提示T1、T2和T3可以合并为新的T1。除N3a和N3b外，其余N期间差异均有统计学意义，提示N3a和N3b可合并为新的N3。此外，I期、II期、III期和IVa期的总生存（OS）曲线差异无统计学意义。因此，我们提出基于磁共振成像（MRI）和IMRT的鼻咽癌临床分期新标准：T期（包括T1和T2）、N期（包括N0、N1、N2和N3），临床分期包括I （T1N0M0）、II （T1N1-2M0、T2N0M0）、III （T2N1-2M0）、IVa （TxN3M0）和IVb （TxNxM1）。推荐分期系统在风险差异和分配平衡方面表现较好。此外，5年局部无复发生存期（LRFS）、远处无转移生存期（DMFS）和OS的差异均比第七版UICC/AJCC分期系统具有统计学意义。所提出的分期系统更适应IMRT，更准确地预测鼻咽癌患者的预后。
To establish a new clinical staging standard for nasopharyngeal carcinoma (NPC), based on intensity-modulated radiotherapy (IMRT), through a prospective multicenter clinical trial. 492 NPC patients were selected from six hospitals in the Guangxi Zhuang Autonomous Region, China from January 2006 to December 2009. Kaplan-Meier method was adopted to calculate survival rates. Log-rank test was used to compare survival differences. According to the seventh edition of the UICC/AJCC staging system, the differences between T1, T2 and T3 are not statistically significant, suggesting that T1, T2 and T3 could be combined as new T1. There were significant differences between all N stages except those of N3a and N3b, suggesting that N3a and N3b could be combined as new N3. Additionally, the overall survival (OS) curves of stages I, II, III and IVa were not significantly different. Therefore, we propose a new clinical NPC staging standard based on magnetic resonance imaging (MRI) and IMRT as T stage (including T1 and T2), N stage (including N0, N1, N2 and N3) and clinical staging includes I (T1N0M0), II (T1N1-2M0, T2N0M0), III (T2N1-2M0), IVa (TxN3M0) and IVb (TxNxM1). Recommended staging system performs better in risk difference and distribution balance. Furthermore, the differences in the 5-year curves of local relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and OS were all statistically more significant than the seventh edition of the UICC/AJCC staging system. Proposed staging system is more adaptable to IMRT and predicts the prognosis of NPC patients more accurately.