非转移性鼻咽癌TNM分期系统第9版的验证：来自高发地区的多中心回顾性分析

文献信息

中文摘要

目的： 评估并比较美国癌症联合委员会（AJCC）/国际抗癌联盟（UICC）分期系统第8版与第9版对非转移性鼻咽癌（NPC）患者的预后价值。
方法： 回顾性分析2019年11月至2022年6月期间接受治疗的470例鼻咽癌患者的临床数据。根据AJCC/UICC分期系统第8版和第9版对患者重新分期。主要终点为OS；次要终点包括局部区域无复发生存期（LRFS）、无远处转移生存期（DMFS）和无病生存期（DFS）。采用整体和对数秩检验比较Kaplan-Meier曲线。采用一致性指数（C-index）和赤池信息量准则（AIC）评估预后区分能力。
结果： 17例（3.6%）在TNM-8中被归类为T3的患者在TNM-9中被重新归类为T4。31例（6.6%）因晚期iENE被重新归类为N3。TNM-9改善了N分期对DMFS的区分能力（对数秩p < 0.001，而TNM-8为p = 0.016）以及OS（p < 0.001，而TNM-8为p = 0.042）。两个版本的T分期均可区分LRFS（两者p = 0.012），而OS差异无统计学意义（TNM-8 p = 0.139；TNM-9 p = 0.137）。TNM-9总体分期可区分OS（p = 0.002），而TNM-8则不能（p = 0.121）。两个版本均可区分DFS（两者p < 0.001），但TNM-9在早期与晚期总体分期之间提供了更好的两两区分。与第8版相比，第9版表现出更强的预测性能，这体现在总体分期的DFS和OS预测中具有更高的一致性指数值和更低的赤池信息量准则（AIC）值。
结论： 与第8版相比，AJCC/UICC分期系统第9版表现出更优的预后区分能力，能够实现更准确的风险分层，并支持对鼻咽癌患者进行更明智的临床决策。

英文摘要

OBJECTIVE: To evaluate and compare the prognostic value of the 8th and 9th editions of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system in patients with non-metastatic nasopharyngeal carcinoma (NPC).
METHODS: Clinical data from 470 patients with NPC treated between November 2019 and June 2022 were retrospectively analyzed. Patients were restaged according to the 8th and 9th editions of the AJCC/UICC staging system. OS was the primary endpoint; locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) were secondary endpoints. Kaplan-Meier curves were compared using global and pairwise log-rank tests. Prognostic discriminative ability was evaluated using the concordance index (C-index) and Akaike information criterion (AIC).
RESULTS: Seventeen patients (3.6%) classified as T3 by TNM-8 were reclassified as T4 by TNM-9. Thirty-one patients (6.6%) were reclassified to N3 because of advanced iENE. TNM-9 improved discrimination for DMFS across N categories (log-rank p < 0.001 vs. p = 0.016 for TNM-8) and for OS (p < 0.001 vs. p = 0.042). T categories discriminated LRFS in both editions (p = 0.012 for each), whereas OS differences were not significant (TNM-8 p = 0.139; TNM-9 p = 0.137). TNM-9 overall stage discriminated OS (p = 0.002), unlike TNM-8 (p = 0.121). Both editions discriminated DFS (both p < 0.001), but TNM-9 provided better pairwise separation between early and advanced overall stages. The 9th edition exhibited enhanced predictive performance compared with the 8th edition, as evidenced by higher C-index values and lower Akaike information criterion (AIC) values for both DFS and OS prediction across overall stages.
CONCLUSION: The 9th edition of the AJCC/UICC staging system demonstrated superior prognostic discriminative ability compared with the 8th edition, enabling more accurate risk stratification and supporting more informed clinical decision-making for patients with NPC.