Staging of nasopharyngeal carcinoma: evaluation of N-staging by Ho and UICC/AJCC systems. Union Internationale Contre le Cancer. American Joint Committee for Cancer.
To evaluate the prognostic accuracy of N-staging by Ho's and the UICC/AJCC systems, 5020 patients with undifferentiated or poorly differentiated squamous cell carcinoma of the nasopharynx treated at the Queen Elizabeth Hospital, Hong Kong in the period 1976-1985 were analysed retrospectively. They were initially staged with Ho's system, but detailed records of nodal involvement allowed accurate retrospective restaging with the UICC/ AJCC (1988) system. Staging assessment depended almost entirely on physical examination; only 14% of patients had additional investigations with computed tomography. To evaluate the independent significance of different nodal parameters, T-stage adjusted analyses of the 4730 patients presenting without distant metastases were performed. Both N-staging systems showed a strongly significant overall correlation with distant failures and cancer-specific deaths. A significant trend was also shown for nodal failures in node-positive patients. Ho's system was superior in predicting distant failures, while the UICC/AJCC system was superior for nodal failures. However, even with due adjustment for level, the independent significance of nodal size, laterality and fixity could be demonstrated. After adjustment for UICC/AJCC N-stage, both level and fixity were also significant. Furthermore, when adjusted for all other meaningful parameters, there were no significant differences between ipsilateral and contralateral involvement, upper and mid-level extent, and nodal size < or = 3 cm or > 3- < or = 6 cm. N-staging can be further optimized by a newly proposed system incorporating fixity (movable versus fixed), level (upper-mid versus lower), size (greatest diameter < or = 6 cm versus > 6 cm), and laterality (unilateral versus bilateral) as staging criteria.
Lee
A W
AW
Pamela Youde Nethersole Eastern Hospital, Hong Kong.
Foo
W
W
Poon
Y F
YF
Law
C K
CK
Chan
D K
DK
O
S K
SK
Tung
S Y
SY
Ho
J H
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000532:radiotherapy / Q000556:secondary; D002648:Child; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009303:Nasopharyngeal Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D009367:Neoplasm Staging / Q000379:methods*; D010808:Physical Examination; D011379:Prognosis; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D016896:Treatment Outcome