Jian Ji Pan1,2, Wai Tong Ng3, Jing Feng Zong1,2, Lucy L K Chan3, Brian O'Sullivan4, Shao Jun Lin1,2, Henry C K Sze5, Yun Bin Chen6, Horace C W Choi7, Qiao Juan Guo1,2, Wai Kuen Kan8, You Ping Xiao6, Xu Wei9, Quynh Thu Le10, Christine M Glastonbury11, A Dimitrios Colevas12, Randal S Weber13, Jatin P Shah14, Anne W M Lee15. 1. Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, China. 2. Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, China. 3. Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China. 4. Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada. 5. Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China. 6. Department of Radiology, Fujian Provincial Cancer Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, China. 7. Department of Systems Engineering and Engineering Management, City University of Hong Kong, Hong Kong, China. 8. Department of Diagnostic Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China. 9. Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada. 10. Department of Radiation Oncology, Stanford University, Stanford, California. 11. Department of Clinical Radiology, University of California, San Francisco, California. 12. Department of Medicine (Oncology), Stanford Cancer Institute, Stanford University, Stanford, California. 13. Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas. 14. Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York. 15. Clinical Oncology Center, University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Abstract
BACKGROUND: An accurate staging system is crucial for cancer management. Evaluations for continual suitability and improvement are needed as staging and treatment methods evolve. METHODS: This was a retrospective study of 1609 patients with nasopharyngeal carcinoma investigated by magnetic resonance imaging, staged with the 7th edition of the American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) staging system, and irradiated by intensity-modulated radiotherapy at 2 centers in Hong Kong and mainland China. RESULTS: Among the patients without other T3/T4 involvement, there were no significant differences in overall survival (OS) between medial pterygoid muscle (MP) ± lateral pterygoid muscle (LP), prevertebral muscle, and parapharyngeal space involvement. Patients with extensive soft tissue involvement beyond the aforementioned structures had poor OS similar to that of patients with intracranial extension and/or cranial nerve palsy. Only 2% of the patients had lymph nodes > 6 cm above the supraclavicular fossa (SCF), and their outcomes resembled the outcomes of those with low extension. Replacing SCF with the lower neck (extension below the caudal border of the cricoid cartilage) did not affect the hazard distinction between different N categories. With the proposed T and N categories, there were no significant differences in outcome between T4N0-2 and T1-4N3 disease. CONCLUSIONS: After a review by AJCC/UICC preparatory committees, the changes recommended for the 8th edition include changing MP/LP involvement from T4 to T2, adding prevertebral muscle involvement as T2, replacing SCF with the lower neck and merging this with a maximum nodal diameter > 6 cm as N3, and merging T4 and N3 as stage IVA criteria. These changes will lead not only to a better distinction of hazards between adjacent stages/categories but also to optimal balance in clinical practicability and global applicability.
BACKGROUND: An accurate staging system is crucial for cancer management. Evaluations for continual suitability and improvement are needed as staging and treatment methods evolve. METHODS: This was a retrospective study of 1609 patients with nasopharyngeal carcinoma investigated by magnetic resonance imaging, staged with the 7th edition of the American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) staging system, and irradiated by intensity-modulated radiotherapy at 2 centers in Hong Kong and mainland China. RESULTS: Among the patients without other T3/T4 involvement, there were no significant differences in overall survival (OS) between medial pterygoid muscle (MP) ± lateral pterygoid muscle (LP), prevertebral muscle, and parapharyngeal space involvement. Patients with extensive soft tissue involvement beyond the aforementioned structures had poor OS similar to that of patients with intracranial extension and/or cranial nerve palsy. Only 2% of the patients had lymph nodes > 6 cm above the supraclavicular fossa (SCF), and their outcomes resembled the outcomes of those with low extension. Replacing SCF with the lower neck (extension below the caudal border of the cricoid cartilage) did not affect the hazard distinction between different N categories. With the proposed T and N categories, there were no significant differences in outcome between T4N0-2 and T1-4N3 disease. CONCLUSIONS: After a review by AJCC/UICC preparatory committees, the changes recommended for the 8th edition include changing MP/LP involvement from T4 to T2, adding prevertebral muscle involvement as T2, replacing SCF with the lower neck and merging this with a maximum nodal diameter > 6 cm as N3, and merging T4 and N3 as stage IVA criteria. These changes will lead not only to a better distinction of hazards between adjacent stages/categories but also to optimal balance in clinical practicability and global applicability.
Authors: Wai Tong Ng; Michael C H Lee; Wai Man Hung; Cheuk Wai Choi; Kin Chung Lee; Oscar S H Chan; Anne W M Lee Journal: Int J Radiat Oncol Biol Phys Date: 2010-05-06 Impact factor: 7.038
Authors: A W Lee; W Foo; S C Law; Y F Poon; S K O; S Y Tung; W M Sze; R Chappell; W H Lau; J H Ho Journal: Int J Cancer Date: 1999-04-20 Impact factor: 7.396
Authors: Jian Ji Pan; Wai Tong Ng; Jing Feng Zong; Sarah W M Lee; Horace C W Choi; Lucy L K Chan; Shao Jun Lin; Qiao Juan Guo; Henry C K Sze; Yun Bin Chen; You Ping Xiao; Wai Kuen Kan; Brian O'Sullivan; Wei Xu; Quynh Thu Le; Christine M Glastonbury; A Dimitrios Colevas; Randal S Weber; William Lydiatt; Jatin P Shah; Anne W M Lee Journal: Cancer Date: 2016-07-19 Impact factor: 6.860
Authors: Qi-Yong Ai; Chen-Wen Hu; Kunwar S Bhatia; Darren M C Poon; Edwin P Hui; Frankie K F Mo; Benjamin King Hong Law; Macy Tong; Brigette B Ma; Anthony T C Chan; Ann D King Journal: Eur Arch Otorhinolaryngol Date: 2017-11-29 Impact factor: 2.503
Authors: Kenneth C W Wong; Edwin P Hui; Kwok-Wai Lo; Wai Kei Jacky Lam; David Johnson; Lili Li; Qian Tao; Kwan Chee Allen Chan; Ka-Fai To; Ann D King; Brigette B Y Ma; Anthony T C Chan Journal: Nat Rev Clin Oncol Date: 2021-06-30 Impact factor: 66.675