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Comparative Study
. 2018 May 29;18(1):606.
doi: 10.1186/s12885-018-4419-1.

Comparison of the seventh and eighth editions of the UICC/AJCC staging system for nasopharyngeal carcinoma: analysis of 1317 patients treated with intensity-modulated radiotherapy at two centers

Xing-Li Yang  1 , Yan Wang  2 , Shao-Bo Liang  3   4 , Sha-Sha He  1 , Dan-Ming Chen  2 , Hai-Yang Chen  5 , Li-Xia Lu  6   7 , Yong Chen  8
Affiliations
Comparative Study

Comparison of the seventh and eighth editions of the UICC/AJCC staging system for nasopharyngeal carcinoma: analysis of 1317 patients treated with intensity-modulated radiotherapy at two centers

Xing-Li Yang et al. BMC Cancer. .

Abstract

Background: In the intensity-modulated radiotherapy (IMRT) era, great improvement has been made in survival of nasopharyngeal carcinoma (NPC). The 7th edition of the International Union against Cancer/American Joint Committee on Cancer (UICC/AJCC) staging system seems "outdated " as it mainly based on the study in 2D/3D era, and thus the 8th edition has made some amendments according to recent studies. We aimed to compare and evaluate these two editions of staging system for NPC in patients treated with intensity-modulated radiotherapy.

Methods: A total of 1317 patients with biopsy-proven, non-metastatic NPC treated with IMRT between 2009 and 2014 at two institutions were retrospectively assessed. All patients were assessed by magnetic resonance imaging and restaged according to the 7th and 8th editions. Prognostic factors for local relapse-free survival (LRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) were assessed and compared using the Kaplan-Meier method and log-rank test. The Cox proportional hazards model was also used to calculate the hazard ratio (HR).

Results: In both 7th and 8th edition, insignificant difference could be observed between T2 and T3 disease, T2 and T4 disease (all P > 0.05) for LRFS, while the difference of LRFS between T3 and T4 disease was significant in the previous edition (P = 0.001) but insignificant (P = 0.279) after revision. For OS, highly similar survival curve could be seen between T2 and T3 disease in both edition (all P > 0.1). DMFS and OS were not significantly different between N3a and N1-3b categories of the 7th edition (all P > 0.05). In contrast, obvious segregation was observed between N3 and the other N categories after the revision and combination in the 8th edition (all P < 0.05). DFS and OS were not significantly different between stage IVA and IVB of the 7th edition (P = 0.057 and P = 0.365, respectively); therefore, combining these stages in the 8th edition was reasonable.

Conclusion: The overall stages and N categories of the 8th edition of the UICC/AJCC staging system provide better segregation of survival outcomes than the 7th edition. The 8th edition is also more clinically applicable as it has reduced ambiguity and revised out-of-date definitions. However, the T categories need further optimizing as the 8th edition failed to solve the problem of similar survival between adjacent T-classification, which has been exited since 7th edition.

Keywords: Intensity-modulated radiation therapy; Nasopharyngeal cancer; Prognostication; Staging system.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol was designed in accordance with the guidelines outlined in the Declaration of Helsinki and was approved by the Ethics Committee of the First Hospital of Foshan and Sun Yat-Sen University Cancer Center (South China). The requirement for informed consent was waived due to the retrospective nature of the study.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Survival analyses for the T category classifications of the 7th and 8th edition staging systems. a and c: Local relapse-free survival and overall survival for T categories defined by the 7th edition; b and d: local relapse-free survival and overall survival for T categories defined by the 8th edition
Fig. 2
Fig. 2
Survival analyses for the masticatory space subset compared with other subsets using the 7th edition of the staging system. a and b: Local relapse-free survival and overall survival for MSI without other T3/T4 criteria; c and d: Local relapse-free survival and overall survival for MSI without other T4 criteria
Fig. 3
Fig. 3
Survival analyses for the N category classifications of the 7th and 8th editions of the UICC/AJCC staging system. a and c: Distant metastasis-free survival and overall survival for the N categories of the 7th edition; Panels b and d: Distant metastasis-free survival and overall survival for the N categories of the 8th edition
Fig. 4
Fig. 4
Survival analyses for the lower neck subset compared with other subsets using the 7th edition of the UICC/AJCC staging system. a and b: Distant metastasis-free survival and overall survival for the change from the supraclavicular fossa in the 7th edition to the lower neck in the 8th edition
Fig. 5
Fig. 5
Survival analyses for the overall stages of the 7th and 8th editions of the UICC/AJCC staging system. a and c: Disease-free survival and overall survival for the T categories of the 7th edition; b and d: Disease-free survival and overall survival for the T categories of the 8th edition
See this image and copyright information in PMC

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