title: Impact of intensity-modulated radiotherapy on nasopharyngeal carcinoma: Validation of the 7th edition AJCC staging system.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the 7th edition UICC/AJCC staging system for nasopharyngeal carcinoma (NPC) patients who were treated with intensity modulated radiation therapy (IMRT).
  
  
  METHODS
  The clinical data of 1241 NPC patients with initial magnetic resonance imaging (MRI) scans were studied retrospectively. All MRIs were independently reevaluated and restaged according to the 7th edition by two radiologists specializing in head and neck cancers. Analysis of prognostic factors in local relapse-free survival (LRFS), distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS) were performed.
  
  
  RESULTS
  The proportion of patients in Stage I, II, III, IVA and IVB were 4.8%, 26.2%, 45.4%, 18.4%, and 5.2%, respectively. The differences of LRFS between T1 and T2, and between T2 and T3 were not significant (P=0.055 and 0.605, respectively). Hazard ratios (HRs) for DSS and OS between T2 and T3 or between T3 and T4 differed significantly, but not between T1 and T2. The differences of DMFS between N0 and N1, between N1 and N2 were significant. However no significant difference was found in DMFS between N2 and N3a, or between N2 and N3b. For patients with T1-T3 disease, although skull base infiltration did not impact local failure, it was an independent prognostic factor for both distant failure and cancer death.
  
  
  CONCLUSIONS
  When treated with IMRT, the difference in the LRFS, DSS, and OS between T1 and T2 patients diminished, indicating that it is rational to merge T2 into T1. The prognostic value of the N classification of the current staging system had not changed much compared to the 6th edition.
authors.affiliation: Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Translational Cancer Medicine (Fujian Provincial Cancer Hospital, Fujian Medical University Union Hospital), Fuzhou, Fujian, People's Republic of China.
authors.forename: Jingfeng
authors.initials: J
authors.lastname: Zong
authors.affiliation: Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Translational Cancer Medicine (Fujian Provincial Cancer Hospital, Fujian Medical University Union Hospital), Fuzhou, Fujian, People's Republic of China. Electronic address: linshaojun@yeah.net.
authors.forename: Shaojun
authors.initials: S
authors.lastname: Lin
authors.affiliation: Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Translational Cancer Medicine (Fujian Provincial Cancer Hospital, Fujian Medical University Union Hospital), Fuzhou, Fujian, People's Republic of China.
authors.forename: Jin
authors.initials: J
authors.lastname: Lin
authors.affiliation: Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Translational Cancer Medicine (Fujian Provincial Cancer Hospital, Fujian Medical University Union Hospital), Fuzhou, Fujian, People's Republic of China.
authors.forename: Linbo
authors.initials: L
authors.lastname: Tang
authors.affiliation: Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Translational Cancer Medicine (Fujian Provincial Cancer Hospital, Fujian Medical University Union Hospital), Fuzhou, Fujian, People's Republic of China.
authors.forename: Bijuan
authors.initials: B
authors.lastname: Chen
authors.affiliation: Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Translational Cancer Medicine (Fujian Provincial Cancer Hospital, Fujian Medical University Union Hospital), Fuzhou, Fujian, People's Republic of China.
authors.forename: Mingwei
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Translational Cancer Medicine (Fujian Provincial Cancer Hospital, Fujian Medical University Union Hospital), Fuzhou, Fujian, People's Republic of China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Translational Cancer Medicine (Fujian Provincial Cancer Hospital, Fujian Medical University Union Hospital), Fuzhou, Fujian, People's Republic of China.
authors.forename: Luying
authors.initials: L
authors.lastname: Xu
authors.affiliation: Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Department of Radiology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China.
authors.forename: Yunbin
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Department of Radiology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China.
authors.forename: Youping
authors.initials: Y
authors.lastname: Xiao
authors.affiliation: Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Department of Radiology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Fang
authors.affiliation: Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Translational Cancer Medicine (Fujian Provincial Cancer Hospital, Fujian Medical University Union Hospital), Fuzhou, Fujian, People's Republic of China. Electronic address: panjianji@126.com.
authors.forename: Jianji
authors.initials: J
authors.lastname: Pan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D055815:Young Adult
keywords: Intensity modulated radiation therapy; Nasopharyngeal cancer; Prognosis; Staging system