Tumor volume/metabolic information can improve the prognostication of anatomy based staging system for nasopharyngeal cancer? Evaluation of the 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer

다국어 초록 (Multilingual Abstract)

Purpose: We evaluated prognostic value of the 8th edition of the American Joint Committee on Cancer/International Union for Cancer Control (AJCC/UICC) staging system for nasopharyngeal cancer and investigated whether tumor volume/metabolic information refined prognostication of anatomy based staging system.
Materials and Methods: One hundred thirty-three patients with nasopharyngeal cancer who were staged with magnetic resonance imaging (MRI) and treated with intensity-modulated radiotherapy (IMRT) between 2004 and 2013 were reviewed.
Multivariate analyses were performed to evaluate prognostic value of the 8th edition of the AJCC/UICC staging system and other factors including gross tumor volume and maximum standardized uptake value of primary tumor (GTV-T and SUV-T).
Results: Median follow-up period was 63 months. In multivariate analysis for overall survival (OS), stage group (stage I-II vs. IIIIVA) was the only significant prognostic factor. However, 5-year OS rates were not significantly different between stage I and II (100% vs. 96.2%), and between stage III and IVA (80.1% vs. 71.7%). Although SUV-T and GTV-T were not significant prognostic factors in multivariate analysis, those improved prognostication of stage group. The 5-year OS rates were significantly different between stage I-II, III-IV (SUV-T ≤ 16), and III-IV (SUV-T > 16) (97.2% vs. 78% vs. 53.8%), and between stage I, II-IV (GTV-T ≤ 33 mL), and II-IV (GTV-T > 33 mL) (100% vs. 87.3% vs. 66.7%).
Conclusion: Current anatomy based staging system has limitations on prognostication for nasopharyngeal cancer despite the most accurate assessment of tumor extent by MRI. Tumor volume/metabolic information seem to improve prognostication of current anatomy based staging system, and further studies are needed to confirm its clinical significance.

참고문헌 (Reference)

1 Wong FC, "Whole-field simultaneous integrated-boost intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma" 76 : 138-145, 2010

2 Feng M, "Tumor volume is an independent prognostic indicator of local control in nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy" 8 : 208-, 2013

3 Kam MK, "Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy: the Hong Kong experience" 60 : 1440-1450, 2004

4 Tham IW, "Treatment of nasopharyngeal carcinoma using intensity-modulated radiotherapy: the National Cancer Centre Singapore experience" 75 : 1481-1486, 2009

5 Chen L, "The seventh edition of the UICC/AJCC staging system for nasopharyngeal carcinoma is prognostically useful for patients treated with intensitymodulated radiotherapy from an endemic area in China" 104 : 331-337, 2012

6 Chen C, "Significance of primary tumor volume and T-stage on prognosis in nasopharyngeal carcinoma treated with intensity-modulated radiation therapy" 41 : 537-542, 2011

7 Liang ZG, "Recommendations for updating T and N staging systems for nasopharyngeal carcinoma in the era of intensity-modulated radiotherapy" 11 : e0168470-, 2016

8 Pan JJ, "Proposal for the 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy" 122 : 546-558, 2016

9 Wu Z, "Prognostic value of tumor volume for patients with nasopharyngeal carcinoma treated with concurrent chemotherapy and intensitymodulated radiotherapy" 140 : 69-76, 2014

10 Lin J, "Prognostic value of 18F-FDG-PET/CT in patients with nasopharyngeal carcinoma: a systematic review and meta-analysis" 8 : 33884-33896, 2017

11 He YX, "Prognostic value and predictive threshold of tumor volume for patients with locally advanced nasopharyngeal carcinoma receiving intensity-modulated radiotherapy" 35 : 96-, 2016

12 Chen YP, "Prognostic value and grading of MRI-based T category in patients with nasopharyngeal carcinoma without lymph node metastasis undergoing intensity-modulated radiation therapy" 94 : e1624-, 2015

13 Pan JJ, "Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy" 122 : 3307-3315, 2016

14 Shen C, "Prognostic impact of primary tumor volume in patients with nasopharyngeal carcinoma treated by definitive radiation therapy" 118 : 1206-1210, 2008

15 Sze WM, "Primary tumor volume of nasopharyngeal carcinoma: prognostic significance for local control" 59 : 21-27, 2004

16 Lee CC, "Primary tumor volume calculation as a predictive factor of prognosis in nasopharyngeal carcinoma" 128 : 93-97, 2008

17 Lee SW, "Prediction of prognosis using standardized uptake value of 2-[(18)F]fluoro-2-deoxy-d-glucose positron emission tomography for nasopharyngeal carcinomas" 87 : 211-216, 2008

18 Jeong Y, "Lymph node standardized uptake values at pre-treatment (18)F-fluorodeoxyglucose positron emission tomography as a valuable prognostic factor for distant metastasis in nasopharyngeal carcinoma" 90 : 20160239-, 2017

19 Guo R, "Is primary tumor volume still a prognostic factor in intensity modulated radiation therapy for nasopharyngeal carcinoma?" 104 : 294-299, 2012

20 Lee N, "Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma:an update of the UCSF experience" 53 : 12-22, 2002

21 Wolden SL, "Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: update of the Memorial Sloan-Kettering experience" 64 : 57-62, 2006

22 Zong J, "Impact of intensity-modulated radiotherapy on nasopharyngeal carcinoma: Validation of the 7th edition AJCC staging system" 51 : 254-259, 2015

23 Chen MK, "Better prediction of prognosis for patients with nasopharyngeal carcinoma using primary tumor volume" 100 : 2160-2166, 2004

24 Zhou Q, "A study of 358 cases of locally advanced nasopharyngeal carcinoma receiving intensity-modulated radiation therapy: improving the seventh edition of the American Joint Committee on Cancer T-staging system" 2017 : 1419676-, 2017

25 Kang M, "A new staging system for nasopharyngeal carcinoma based on intensity-modulated radiation therapy: results of a prospective multicentric clinical study" 7 : 15252-15261, 2016