Article Dans Une Revue JAMA oncology Année : 2024

Ninth Version of the AJCC and UICC Nasopharyngeal Cancer TNM Staging Classification

Jian Ji Pan
  • Fonction : Auteur
Qiao Juan Guo
  • Fonction : Auteur
You Ping Xiao
  • Fonction : Auteur
Shao Jun Lin
  • Fonction : Auteur
Yun Bin Chen
  • Fonction : Auteur
Jun Ma
  • Fonction : Auteur
Michelle Williams
  • Fonction : Auteur
Christine M. Glastonbury
  • Fonction : Auteur
Ann D. King
  • Fonction : Auteur
A. Dimitrios Colevas
  • Fonction : Auteur
Melvin L.K. Chua
  • Fonction : Auteur
Anne W.M. Lee
  • Fonction : Auteur
Hai Qiang Mai
  • Fonction : Auteur
Li Zhi Liu
  • Fonction : Auteur
Shan Shan Guo
  • Fonction : Auteur
Lin Quan Tang
  • Fonction : Auteur
Wai Tong Ng
  • Fonction : Auteur
Victor Lee
  • Fonction : Auteur
Ling Yu Ma
  • Fonction : Auteur
Chi Leung Chiang
  • Fonction : Auteur
Zhi Yuan Xu
  • Fonction : Auteur
Yi Zhen Jia
  • Fonction : Auteur
Chao Su Hu
  • Fonction : Auteur
Ting Ting Xu
  • Fonction : Auteur
Wen Sa Peng
  • Fonction : Auteur
Jin Gao Li
  • Fonction : Auteur
Xiao Chang Gong
  • Fonction : Auteur
Li Ping Hu
  • Fonction : Auteur
Tian Zhu Lu
  • Fonction : Auteur
Xiao Zhong Chen
  • Fonction : Auteur
Meng Yun Qiang
  • Fonction : Auteur
Feng Jiang
  • Fonction : Auteur
Cai Neng Cao
  • Fonction : Auteur
James C.H. Chow
  • Fonction : Auteur
Kwok Hung Au
  • Fonction : Auteur
Edwin Wong
  • Fonction : Auteur
Tsz Chim Liu
  • Fonction : Auteur
Qin Liu
  • Fonction : Auteur
Charlene H.L. Wong
  • Fonction : Auteur
Wei Xu
  • Fonction : Auteur
Shao Hui Huang
  • Fonction : Auteur
Brian O Sullivan
  • Fonction : Auteur
Snehal G. Patel
  • Fonction : Auteur
Raja R. Seethala
  • Fonction : Auteur
William Lydiatt
  • Fonction : Auteur
Dai Ming Fan
  • Fonction : Auteur

Résumé

Accurate staging is a fundamental step in treating patients with nasopharyngeal carcinoma (NPC) worldwide; this is crucial not only for prognostication, but also for guiding treatment decisions. The American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) tumor-node-metastasis (TNM) system is the global language for clinicians, researchers, and cancer registries. Continual improvement that aligns with contemporary pattern of care is essential. Objective: To improve the prognostic accuracy and clinical applicability of the eighth edition (TNM-8) for NPC. Design, Setting, and Participants: This multicenter study analyzed patients with NPC with detailed tumor features during January 2014 and December 2015 and was reviewed by experienced radiologists. The data analysis was completed in December 2023. The findings were further confirmed with internal and external validation. Statistical analyses and clinical considerations were reviewed by the AJCC/UICC multidisciplinary head and neck panels and attained consensus. The recommendations were evaluated by the AJCC Evidence-Based Medicine Committee before final endorsement as the ninth version (TNM-9). Main Outcomes and Measures: The primary end point was overall survival. Adjusted hazard ratios of different subgroups were then assessed for confirmation of optimal stage grouping. Results: Of the 4914 patients analyzed, 1264 (25.7%) were female and 3650 (74.3%) were male; the median (SD) age was 48.1 (12.0) years. Advanced radiological extranodal extension (with involvement of adjacent muscles, skin, and/or neurovascular bundles) was identified as an independent adverse factor for all end points: this was added as a criterion for N3. Patients with nonmetastatic disease were regrouped into stages I to III instead of TNM-8 stages I to IVA. Significant hazard discrimination was achieved by grouping T1-2N0-1 as stage I, T3/N2 as stage II, and T4/N3 as stage III. Although the T1-2N0-1 subgroups had comparable 5-year overall survival, subdivisions into IA (T1-T2N0) and IB (T1-T2N1) were recommended due to the distinction in adjusted hazard ratios following adjustment for chemotherapy use. Metastatic disease was exclusively classified as stage IV, and prognostication was further refined by subdivision into IVA (M1a, ≤3 lesions) and IVB (M1b, >3 lesions). TNM-9 demonstrated superiority compared with TNM-8 in major statistical aspects. Conclusion and Relevance: The results of this diagnostic study suggest that the ninth version of TNM staging for NPC, based on robust analyses and a comprehensive review by the AJCC/UICC staging committees, provides an improved staging system for global application and a framework for future incorporation of nonanatomical factors. This will be launched for global application in January 2025.

Dates et versions

hal-04822516 , version 1 (06-12-2024)

Identifiants

Citer

Jian Ji Pan, Qiao Juan Guo, You Ping Xiao, Shao Jun Lin, Yun Bin Chen, et al.. Ninth Version of the AJCC and UICC Nasopharyngeal Cancer TNM Staging Classification. JAMA oncology, 2024, 10 (12), ⟨10.1001/jamaoncol.2024.4354⟩. ⟨hal-04822516⟩
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