Chung-I Huang1, Li-Fu Chen2,3, Shih-Lun Chang4, Hung-Chang Wu5, Wei-Chen Ting6, Ching-Chieh Yang6,7,8. 1. Department of Radiation Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan. 2. Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan. 3. School of Medicine, National Yang-Ming University, Taipei, Taiwan. 4. Department of Otolaryngology-Head and Neck Surgery, Chi-Mei Medical Center, Tainan, Taiwan. 5. Department of Hematology and Oncology, Chi-Mei Medical Center, Tainan, Taiwan. 6. Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan. 7. Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan. 8. Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
Abstract
Importance: Concurrent chemoradiotherapy delivers a high level of tumor control and survival benefits for patients with nasopharyngeal carcinoma (NPC). However, many uncertainties still exist regarding the outcomes of chemoradiotherapy, making a more precise survival prognostic system necessary. Objective: To introduce a new staging system that combines tumor and clinical characteristics to improve the accuracy of prognosis for patients with NPC. Design, Setting, and Participants: This cohort study enrolled 207 patients with newly diagnosed NPC who underwent concurrent chemoradiotherapy between January 1, 2007, and December 31, 2014, at Chi-Mei Medical Center in Tainan, Taiwan. Data on these patients were collected from the cancer registry database of the Chi-Mei Medical Center. Patients who had a history of cancer or were unable to complete a full course of radiotherapy were excluded. Follow-up was completed on September 30, 2016, and the data analysis was performed from January 1, 2017, to February 28, 2017. Main Outcomes and Measures: The risk factors associated with 5-year disease-specific survival were incorporated into the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer TNM staging system to construct a new prognostic staging system. The χ2 test for linear trend, the Akaike information criterion, and the C statistic were used to evaluate the monotonicity and discriminatory ability of the new prognostic staging system and the AJCC TNM staging system. Results: Of the 207 patients enrolled in the study, 157 (75.8%) were men, and the mean (SD) age was 48 (11) years. Multivariate analysis identified advanced clinical T stage (adjusted hazard ratio [aHR], 3.20; 95% CI, 1.58-6.48), poor performance status (aHR, 2.62; 95% CI, 1.30-5.28), and cumulative cisplatin dose lower than 100 mg/m2 (aHR, 2.28; 95% CI, 1.10-4.74) as independent prognostic factors. The β coefficients from the Cox proportional hazards regression model were used to develop an integer-based, weighted point system; advanced clinical T stage, poor performance, and cumulative cisplatin dose lower than 100 mg/m2 were each assigned a score of 1. The sum of these risk scores was stratified into new stage I (score of 0), new stage II (score of 1), new stage III (score of 2), and new stage IV (score of 3). Compared with the AJCC TNM staging system, the new prognostic staging category had better monotonicity with a higher χ2 value (17.8 vs 25.6) for linear trend, better discriminatory ability with a smaller Akaike information criterion (367 vs 360), and a greater C statistic (0.702 vs 0.740) for 5-year disease-specific survival. Conclusions and Relevance: The new prognostic staging system has a better accuracy of prognosis of survival than the routinely used AJCC TNM staging system and thus is more useful in identifying high-risk patients for more intense treatment and care.
Importance: Concurrent chemoradiotherapy delivers a high level of tumor control and survival benefits for patients with nasopharyngeal carcinoma (NPC). However, many uncertainties still exist regarding the outcomes of chemoradiotherapy, making a more precise survival prognostic system necessary. Objective: To introduce a new staging system that combines tumor and clinical characteristics to improve the accuracy of prognosis for patients with NPC. Design, Setting, and Participants: This cohort study enrolled 207 patients with newly diagnosed NPC who underwent concurrent chemoradiotherapy between January 1, 2007, and December 31, 2014, at Chi-Mei Medical Center in Tainan, Taiwan. Data on these patients were collected from the cancer registry database of the Chi-Mei Medical Center. Patients who had a history of cancer or were unable to complete a full course of radiotherapy were excluded. Follow-up was completed on September 30, 2016, and the data analysis was performed from January 1, 2017, to February 28, 2017. Main Outcomes and Measures: The risk factors associated with 5-year disease-specific survival were incorporated into the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer TNM staging system to construct a new prognostic staging system. The χ2 test for linear trend, the Akaike information criterion, and the C statistic were used to evaluate the monotonicity and discriminatory ability of the new prognostic staging system and the AJCC TNM staging system. Results: Of the 207 patients enrolled in the study, 157 (75.8%) were men, and the mean (SD) age was 48 (11) years. Multivariate analysis identified advanced clinical T stage (adjusted hazard ratio [aHR], 3.20; 95% CI, 1.58-6.48), poor performance status (aHR, 2.62; 95% CI, 1.30-5.28), and cumulative cisplatin dose lower than 100 mg/m2 (aHR, 2.28; 95% CI, 1.10-4.74) as independent prognostic factors. The β coefficients from the Cox proportional hazards regression model were used to develop an integer-based, weighted point system; advanced clinical T stage, poor performance, and cumulative cisplatin dose lower than 100 mg/m2 were each assigned a score of 1. The sum of these risk scores was stratified into new stage I (score of 0), new stage II (score of 1), new stage III (score of 2), and new stage IV (score of 3). Compared with the AJCC TNM staging system, the new prognostic staging category had better monotonicity with a higher χ2 value (17.8 vs 25.6) for linear trend, better discriminatory ability with a smaller Akaike information criterion (367 vs 360), and a greater C statistic (0.702 vs 0.740) for 5-year disease-specific survival. Conclusions and Relevance: The new prognostic staging system has a better accuracy of prognosis of survival than the routinely used AJCC TNM staging system and thus is more useful in identifying high-risk patients for more intense treatment and care.
Authors: Herbert H Loong; Brigette B Y Ma; Sing-Fai Leung; Frankie Mo; Edwin P Hui; Michael K Kam; Stephen L Chan; Brian K H Yu; Anthony T C Chan Journal: Radiother Oncol Date: 2012-01-31 Impact factor: 6.280
Authors: Ladan Saleh-Ebrahimi; Felix Zwicker; Marc W Muenter; Marc Bischof; Katja Lindel; Juergen Debus; Peter E Huber; Falk Roeder Journal: Radiat Oncol Date: 2013-01-24 Impact factor: 3.481