The development and external validation of simplified T category classification for nasopharyngeal carcinoma to improve the prognostic value in the intensity‐modulated radiotherapy era

Tang, Ling‐Long; Liang, Shuli; Huang, Cheng‐Long; Zhang, Fan; Xu, Cheng; Mao, Yan‐Ping; Liu, Tian; Lin, Aihua; Li, Li; Sun, Ying

doi:10.1002/cam4.2131

Cited by 10 publications

(6 citation statements)

References 21 publications

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“…Indeed, Tang et al proposed a simplified T classification (ie, merging T2 and T3 into T2), and confirmed that significant differences in OS, LRFFS, and DFS could be found using the new T categories both in a training set and an external validation cohort. [ 25 ] Moreover, the new stages generated by regrouping the T and N classifications showed significant differences in OS and DFS. [ 25 ]…”

Section: Discussionmentioning

confidence: 99%

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The evolution of the nasopharyngeal carcinoma staging system over a 10-year period: implications for future revisions

Tang

Mao²,

Xu³

et al. 2020

Chinese Medical Journal

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Background The classification criteria and staging groups for nasopharyngeal carcinoma described in the Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) staging system have been revised over time. This study assessed the proportion of patients whose staging and treatment strategy have changed due to revisions of the UICC/AJCC staging system over the past 10 years (ie, from the sixth edition to the eighth edition), to provide information for further refinement. Methods We retrospectively reviewed 1901 patients with non-metastatic nasopharyngeal carcinoma treated in our cancer center between November 2009 and June 2012. The Akaike information criterion and Harrell concordance index were applied to evaluate the performance of the staging system. Results In total, 25 (1.3%) of the 1901 patients who were staged as T2a according to the sixth edition system were downgraded to T1 in the eighth edition; 430 (22.6%) staged as N0 in the sixth edition were upgraded to N1 in the eighth edition; 106 (5.6%) staged as N1/2 in the sixth edition were upgraded to N3 in the eighth edition. In addition, 51 (2.7%) and 25 (1.3%) of the study population were upstaged from stage I to stage II and stage II to stage IVa, respectively; 10 (0.5%) was downgraded from stage II to stage I. The survival curves of adjacent N categories and staging groups defined by eighth classification system were well-separated. However, there was no significant difference in the locoregional failure-free survival ( P = 0.730) and disease-free survival ( P = 0.690) rates between the T2 and T3 categories in the eighth edition classification system. Conclusions Modifications to the tumor-node-metastasis staging system over the past 10 years have resulted in N classification changes in numerous cases. Although the eighth edition tumor-node-metastasis staging system better predicts survival outcomes, the T classification could be simplified in future revisions.

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Section: Discussionmentioning

confidence: 99%

“…[ 25 ] Moreover, the new stages generated by regrouping the T and N classifications showed significant differences in OS and DFS. [ 25 ]…”

Section: Discussionmentioning

confidence: 99%

The evolution of the nasopharyngeal carcinoma staging system over a 10-year period: implications for future revisions

Tang

Mao²,

Xu³

et al. 2020

Chinese Medical Journal

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“…With the technological advances in both diagnostics and treatment, the differences in survival and local control in the T-category has diminished. Eight of the included studies proposed the simplification of the T-category (6,(21)(22)(23)(24)(25)(26)(27); these included three studies that suggested the merging of T1 and T2 disease (21,23,24), one suggested combining of T1, T2, and T3 disease (22), and one proposed a merging of T2 and T3 (27). Other studies proposed simplification of the definition of Tclassification, refinement of T2-T4 disease, and reclassification as T1 and T2 only (6,25,26).…”

Section: T-classificationmentioning

confidence: 99%

Prognostic Factors for Overall Survival in Nasopharyngeal Cancer and Implication for TNM Staging by UICC: A Systematic Review of the Literature

Chiang

Guo

et al. 2021

Front. Oncol.

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This study aims to identify prognostic factors in nasopharyngeal carcinoma (NPC) to improve the current 8th edition TNM classification. A systematic review of the literature reported between 2013 and 2019 in PubMed, Embase, and Scopus was conducted. Studies were included if (1) original clinical studies, (2) ≥50 NPC patients, and (3) analyses on the association between prognostic factors and overall survival. The data elements of eligible studies were abstracted and analyzed. A level of evidence was synthesized for each suggested change to the TNM staging and prognostic factors. Of 5,595 studies screened, 108 studies (44 studies on anatomical criteria and 64 on non-anatomical factors) were selected. Proposed changes/factors with strong evidence included the upstaging paranasal sinus to T4, defining parotid lymph node as N3, upstaging N-category based on presence of lymph node necrosis, as well as the incorporation of non-TNM factors including EBV-DNA level, primary gross tumor volume (GTV), nodal GTV, neutrophil-lymphocyte ratio, lactate dehydrogenase, C-reactive protein/albumin ratio, platelet count, SUVmax of the primary tumor, and total lesion glycolysis. This systematic review provides a useful summary of suggestions and prognostic factors that potentially improve the current staging system. Further validation studies are warranted to confirm their significance.

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“…Particularly, the prognostic value of the T category is weaker than the previous. Even though modifications have been made in the updated staging system, it is still challenging to predict local control purely based on this system [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic significance of MRI-based late-course tumor volume in locoregionally advanced nasopharyngeal carcinoma

Yan

Feng

et al. 2022

Radiat Oncol

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Background To validate tumor volume-based imaging markers for predicting local recurrence-free survival (LRFS) in locoregionally advanced nasopharyngeal carcinoma patients, who underwent induction chemotherapy followed by definitive intensity-modulated radiotherapy. Methods We enrolled 145 patients with stage III–IVA nasopharyngeal carcinoma in this retrospective study. Pre-treatment tumor volume (Vpre) and late-course volume (LCV) were measured based on the MRIs scanned before treatment and during the first 3 days in the sixth week of radiotherapy, respectively. The volume regression rate (VRR) was calculated according to Vpre and LCV. Receiver operating characteristic (ROC) curves were used to identify the cut-off best separating patient subgroups in assessing the prognostic value of Vpre, LCV and VRR. The Kaplan–Meier method was used for survival analysis. Prognostic analyses were performed using univariate and multivariate COX proportional hazard models. Results The LCV was 5.3 ± 0.5 (range 0–42.1) cm3; The VRR was 60.4 ± 2.2% (range 2.9–100.0). The median follow-up period was 36 months (range 6–98 months). The cut-off value of LCV determined by the ROC was 6.8 cm3 for LRFS prediction (sensitivity 68.8%; specificity 79.8%). The combination of LCV and VRR for LRFS prediction (AUC = 0.79, P < 0.001, 95% CI 0.67–0.90), LCV (AUC = 0.74, P = 0.002, 95% CI 0.60–0.88) and Vpre (AUC = 0.71, P = 0.007, 95% CI 0.56–0.85) are better than T category (AUC = 0.64, P = 0.062, 95% CI 0.50–0.79) alone. Patients with LCV ≤ 6.8 cm3 had significantly longer LRFS (P < 0.001), disease-free survival (DFS, P < 0.001) and overall survival (OS, P = 0.005) than those with LCV > 6.8 cm3. Multivariate Cox regression showed LCV was the only independent prognostic factor for local control (HR = 7.80, 95% CI 2.69–22.6, P < 0.001). Conclusions LCV is a promising prognostic factor for local control and chemoradiosensitivity in patients with locoregionally advanced NPC. The LCV, and the combination of LCV with VRR are more robust predictors for patient survival than T category.

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The development and external validation of simplified T category classification for nasopharyngeal carcinoma to improve the prognostic value in the intensity‐modulated radiotherapy era

Cited by 10 publications

References 21 publications

The evolution of the nasopharyngeal carcinoma staging system over a 10-year period: implications for future revisions

The evolution of the nasopharyngeal carcinoma staging system over a 10-year period: implications for future revisions

Prognostic Factors for Overall Survival in Nasopharyngeal Cancer and Implication for TNM Staging by UICC: A Systematic Review of the Literature

Prognostic significance of MRI-based late-course tumor volume in locoregionally advanced nasopharyngeal carcinoma

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