Nasopharyngeal carcinoma
Staging of nasopharyngeal carcinoma investigated by magnetic resonance imaging

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Abstract

Background and purpose

To investigate the American Joint Commission on Cancer (AJCC) sixth edition staging system of nasopharyngeal carcinoma (NPC) by Magnetic Resonance Imaging (MRI).

Patients and methods

One hundred and fifty-nine non-disseminated biopsy-proven NPC patients were studied with MRI before treatment. Retrieval of MRI information enabled us to restage all patients accurately according to the sixth edition of the AJCC staging system. Splitting the respective T and N stages by the significant defining factors identified, the cancer death hazard ratios were modeled by the Cox model in SPSS 10.0 for windows (SPSS Inc, Chicago, IL).

Results

Single site of skull base abnormality (HR=3.91, 95% CI: 0.74–20.56) has a superior result to others involved in T3 (HR=5.83, 95% CI: 1.24–27.29). Involvement of either anterior or posterior cranial nerves solely (HR=6.02, 95% CI: 1.55–35.60) was not found to be as a poor prognostic indicator as others involved in T4 (HR=7.81, 95% CI: 1.81–33.63). Less than or equal to 3 cm of N1 (HR=4.01, 95% CI: 0.48–33.83) and N2 (HR=4.72, 95% CI: 0.62–35.78) have a better result than >3 cm of N1 (HR=8.09, 95% CI: 0.95–68.97) and N2 (HR=10.58, 95% CI: 1.32–84.62), respectively.

Conclusions

Perhaps, it is better to down-stage single site of skull base abnormality from T3 to T2, and involvement of either anterior or posterior cranial nerves solely from T4 to T3, meanwhile, ≤3 cm of N2 down-stage to N1, >3 cm of N1 up-stage to N2.

Section snippets

Patients

From October 1992 to September 2000, 159 non-disseminated biopsy-proven NPC patients were studied with MRI before treatment: 120 patients were male and 39 female, ranging in age from 14 to 75 years (median age, 47 years). Because of no supraclavicular fossa node metastasis in our series, N stage was defined according to which has more extensive invasion range, retropharyngeal nodes (RN) and cervical nodes (CN). We defined those nodes as abnormal if diameter of CN was larger than 1 cm or RN

Results

Until last follow-up, 40 patients had died. The 1-, 3-, and 5-year OS were 98.7, 85.1, and 77.4%, respectively. Twenty-eight patients presented with recurrence, including 16 in the primary site, 10 in regional node, 2 in both. The 1-, 3-, and 5-year LFF were 97.5, 88.0, and 84.0%, respectively. Thirty-three patients presented with distant metastasis, the most site involved was bone (19 patients), followed by lung (12 patients), liver (9 patients), and others (9 patients). Seven patients were

Discussion

The tumor-node-metastasis (TNM) classification is a worldwide benchmark for reporting the extent of malignant disease and is a major prognostic factor in predicting the outcome of patients with cancer [9]. In 1997, The AJCC fifth edition [8] represented the first concerted effort to design a universally acceptable system by incorporating the strengths of different TNM systems. Thus far, evaluations of the system consistently confirm its superiority over previous systems, in terms of improved

Acknowledgements

We thank Dr Senqing Chen for his helpful review of the manuscript.

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