鼻咽癌UICC第7版分期与中国2008分期比较及分期更新建议

目的 比较鼻咽癌UICC第7版分期及中国2008分期, 并对分期的更新提供参考依据。方法 回顾分析2006—2012年病理确诊的初治无远处转移、接受调强适形放疗的鼻咽癌患者767例。以OS、LRFS、DMFS为主要预后指标, 比较两种分期系统T分期、N分期、临床分期对预后的预测价值。Kaplan-Meier法计算各项生存率, 组间差异比较行Logrank检验, Cox法多因素分析。结果 从T分期来看, 中国2008分期在预测OS、LFFS方面优于UICC分期。从N分期来看, 两种分期在预测OS、DMFS方面相当。从临床分期来看, UICC分期在预测OS方面优于中国2008分期。依据统计结果推荐的新分期中T分期、N分期、临床分期对预后均有较好预测价值。结论 鼻咽癌UICC第7版分期与中国2008分期在预测预后方面各有优势。推荐的新分期方案对当前鼻咽癌分期的更新有一定价值。

Comparison between the 7th edition of International Union Against Cancer staging system and the Chinese 2008 staging system for nasopharyngeal carcinoma and suggestions for the updating of the staging system

Objective To compare the 7^th edition of International Union Against Cancer (UICC) staging system with the Chinese 2008 staging system for nasopharyngeal carcinoma (NPC), and to provide evidence for further updating of the staging system. Methods A retrospective analysis was performed among 767 patients who were pathologically and newly diagnosed with non-metastatic NPC and treated with intensity-modulated radiotherapy from 2006 to 2012. Based on the main prognostic indices, overall survival (OS), locoregional failure-free survival(LFFS)local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) rates, the value of T stage, N stage, and clinical stage in prognostic prediction was compared between the two staging systems. The Kaplan-Meier method was used for calculating survival rates. The log-rank test was used for survival difference analysis. The Cox model was used for multivariate prognostic analysis. Results In terms of T stage, the Chinese 2008 staging system was a significantly better predictor of the OS and LRFS rates than the 7^th edition of UICC staging system. In terms of N stage, they were comparable in the prediction of the OS and DMFS rates. In terms of clinical stage, the 7^th edition of UICC staging system was a significantly better predictor of the OS rate than the Chinese 2008 staging system. For the new staging system proposed based on the statistical results, the T, N, and clinical staging gave significantly better prognostic prediction. Conclusions The 7^th edition of UICC staging system and the Chinese 2008 staging system for NPC have their own advantages in prognostic prediction. The new staging system proposed in this study could contribute to the updating of the current staging system for NPC.