基于第9版AJCC/UICC TNM分期系统在中国非流行区对鼻咽癌N分期的验证与优化：一项多中心队列研究
Validation and refinement of the N classification for nasopharyngeal carcinoma based on the 9th version AJCC/UICC TNM staging system in non-endemic regions of China: a multicenter cohort study.
文献信息
| PMID | 42756520 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2027 |
| 作者 | Tong Jin |
| 作者单位 | Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing 210009, China. |
| 期刊 | Clinical and translational radiation oncology |
| SCI 分区 | Q1 |
| IF | 3.4 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
第9版AJCC/UICC鼻咽癌（NPC）N分期的适用性在非流行区仍不确定，尤其是将晚期结外扩展（ENE）纳入N3类别方面。我们开展了一项回顾性多中心研究，纳入2011年至2021年间在中国东部接受治疗的1356例NPC患者。所有患者均按照第8版和第9版系统进行分期。采用Kaplan-Meier和Cox回归方法分析生存结局，包括总生存期（OS）、无进展生存期（PFS）、无远处转移生存期（DMFS）和区域无复发生存期（RRFS）。使用一致性指数（C-index）和赤池信息量准则（AIC）评估模型性能。在第9版下，136例晚期ENE患者从N1-N2升级至N3，导致在所有终点上N3与N0-N2组之间的分离更清晰。升级至N3的患者与常规N3疾病患者之间未观察到生存结局的统计学显著差异。与第8版相比，第9版显示C-index有统计学显著但小幅度的增加。然而，时间依赖性AUC差异在不同生存终点和随访时间点之间有所变化。在N3亚组内，晚期ENE与显著更差的OS、PFS和DMFS相关，并且仍是OS（HR 1.78，p=0.032）和DMFS（HR 2.03，p=0.009）的独立预测因子。总之，第9版N分期在该非流行队列中显示出适度的增量预后性能，主要由识别高风险N3疾病驱动。这些发现支持晚期ENE的分期相关性，尽管仍需纳入额外临床和生物学预测因子的前瞻性验证。
英文摘要
The applicability of the ninth version AJCC/UICC N classification for nasopharyngeal carcinoma (NPC) in non-endemic regions remains uncertain, particularly regarding the incorporation of advanced extranodal extension (ENE) into the N3 category. We conducted a retrospective multicenter study including 1356 patients with NPC treated between 2011 and 2021 in eastern China. All patients were staged according to both the eighth and ninth version systems. Survival outcomes, including overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and regional recurrence-free survival (RRFS), were analyzed using Kaplan-Meier and Cox regression methods. Model performance was evaluated using the concordance index (C-index) and Akaike information criterion (AIC). Under the ninth version, 136 patients with advanced ENE were upstaged from N1-N2 to N3, resulting in clearer separation between N3 and N0-N2 groups across all endpoints. No statistically significant differences in survival outcomes were observed between patients upstaged to N3 and those with conventional N3 disease. The ninth version showed statistically significant but small increases in C-index compared with the eighth version. However, time-dependent AUC differences varied across survival endpoints and follow-up time points. Within the N3 subgroup, advanced ENE was associated with significantly worse OS, PFS, and DMFS, and remained an independent predictor of OS (HR 1.78, p = 0.032) and DMFS (HR 2.03, p = 0.009). In conclusion, the ninth version N classification showed modest incremental prognostic performance in this non-endemic cohort, driven primarily by the identification of high-risk N3 disease. These findings support the staging relevance of advanced ENE, although prospective validation incorporating additional clinical and biological predictors remains necessary.