Prognostic differences of nasopharyngeal carcinoma patients treated with intensity-modulated radiothe-rapy with different T staging of the seventh and eighth edition of the UICC staging system

doi:10.3760/cma.j.cn371439-20201214-00100

Abstract

Abstract:

Objective To compare the differences in population distribution and prognosis of patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT) in T staging of the Union for International Cancer Control (UICC) 7th edition and UICC 8th edition, and to analyze the prognostic factors in patients with NPC. Methods The clinicopathologic date of 184 patients with newly diagnosed NPC treated with IMRT at the Department of Radiation Oncology of Weifang People's Hospital of Shandong Province from June 1, 2005 to December 31, 2017 were retrospectively analyzed. All patients were restaged according to the 7th and 8th edition of the UICC staging system. The distribution of T staging of patients in the two staging systems was analyzed, and the consistency of the two staging systems was compared using the Kappa consistency test. Kaplan-Meier method was used for survival analysis, and log-rank test was used to compare the prognostic differences among T stages. Cox regression model was used to analyze the prognostic factors of patients with NPC. Results Of all 184 patients with NPC, stage T₁, T₂, T₃ and T₄ respectively accounted for 18.5% (34/184), 16.8% (31/184), 15.2% (28/184) and 49.5% (91/184) according to the 7th edition UICC staging system. However, stage T₁, T₂, T₃ and T₄ respectively accounted for 18.5% (34/184), 34.2% (63/184), 30.4% (56/184) and 16.8% (31/184) according to the 8th edition UICC staging system. The T staging population distribution of the two staging systems showed moderate consistency (Kappa=0.58). There was a statistically significant difference in overall survival (OS) among patients with stage T₁, T₂, T₃, T₄ according to the 7th edition UICC staging system (χ²=10.606, P=0.014). There were statistically significant differences in OS between stage T₁ and stage T₂, T₃, T₄ (χ ²=4.866, P=0.027; χ ²=11.965, P=0.001; χ ²=4.351, P=0.037). The OS curves of stage T₂ and T₄ could not be separated. Moreover, the OS curves of stage T₃ and T₄ were distributed in reverse order. There was a statistically significant difference in OS among patients with stage T₁, T₂, T₃, T₄ according to the 8th edition staging system (χ ²=8.663, P=0.034). There were statistically significant differences in OS between stage T₁ and stage T₃, T₄(χ ²=8.746, P=0.003; χ ²=7.580, P=0.006). The OS curves of stage T₁ to T₄ were distributed in order, but the curves of stage T₃ and T₄ could not be separated. There was a statistically significant difference in progression-free survival (PFS) among patients with stage T₁, T₂, T₃, T₄ according to the 7th edition UICC staging system (χ ²=11.289, P=0.010). There were statistically significant differences in PFS between stage T₁ and stage T₂, T₃, T₄ (χ ²=8.209, P=0.004; χ ²=13.302, P<0.001; χ ²=6.550, P=0.010). The PFS curves of stage T₂ and T₄ could not be separated. Moreover, the PFS curves of stage T₃ and T₄ were distributed in reverse order. There was a statistically significant difference in PFS among patients with stage T₁, T₂, T₃, T₄ according to the 8th edition staging system (χ ²=12.074, P=0.007). There were statistically significant differences in PFS between stage T₁ and stage T₂, T₃, T₄(χ ²=5.182, P=0.023; χ ²=11.217, P=0.001; χ ²=10.174, P=0.001). The PFS curves of stage T₁ to T₄ were distributed in order, but the curves of stage T₃ and T₄ could not be separated. The results of Cox multivariate analysis showed that T staging of both staging systems were the independent prognostic factors of the OS (P=0.013; P=0.026) and PFS (P=0.031; P=0.012). However, T staging of the two editions were not the independent prognostic factors of the local recurrence-free survival (LRFS) (P=0.351; P=0.167) and distant metastasis-free survival (DMFS) (P=0.059; P=0.052). The age was the independent prognostic factor of the OS (HR=2.70, 95%CI: 1.53-4.76, P=0.001; HR=2.74, 95%CI: 1.55-4.84, P=0.001), PFS (HR=2.72, 95%CI: 1.46-5.08, P=0.002; HR=2.94, 95%CI: 1.57-5.52, P=0.001), LRFS (HR=5.87, 95%CI: 1.62-21.27, P=0.007; HR=6.02, 95%CI: 1.61-22.49, P=0.008) and DMFS (HR=2.40, 95%CI: 1.22-4.72, P=0.011; HR=2.63, 95%CI: 1.34-5.18, P=0.005). N staging was the independent prognostic factor of the OS (P=0.031; P=0.028). Conclusion The T staging population distribution of the 7th and 8th edition UICC staging system had moderate consistency, and the T staging of the 8th edition is more advantageous in predicting the prognosis of OS and PFS. In both editions, T staging is an independent prognostic factor for OS and PFS.

Key words: Nasopharyngeal neoplasms, Radiotherapy, Neoplasm staging, Prognosis

Chen Fangming, Cai Yuanyuan, Li Han, Wang Xiaoli, Kan Hongxing, Li Yang, Hao Furong, Wang Mingchen. Prognostic differences of nasopharyngeal carcinoma patients treated with intensity-modulated radiothe-rapy with different T staging of the seventh and eighth edition of the UICC staging system[J]. Journal of International Oncology, 2021, 48(9): 515-522.

Figures/Tables 6

References 13

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一般临床特征	例(%)	一般临床特征	例(%)
性别		病理类型
男	136(73.9)		角化型鳞状细胞癌	22(12.0)
女	48(26.1)		角化型鳞状细胞癌	22(12.0)
年龄(岁)			非角化型鳞状细胞癌	162(88.0)
<54	97(52.7)		非角化型鳞状细胞癌
≥54	87(47.3)		N分期
治疗方案			N₀	11(6.0)
单纯放疗	62(33.7)		N₁	60(32.6)
同步放化疗	60(32.6)		N₂	86(46.7)
非同步联合放化疗	62(33.7)		N₃	27(14.7)

UICC 7版分期	UICC 8版分期				合计
UICC 7版分期	T₁	T₂	T₃	T₄	合计
T₁	34(18.5)	0(0)	0(0)	0(0)		34(18.5)
T₂	0(0)	31(16.8)	0(0)	0(0)		31(16.8)
T₃	0(0)	0(0)	28(15.2)	0(0)		28(15.2)
T₄	0(0)	32(17.4)	28(15.2)	31(16.8)		91(49.5)
合计	34(18.5)	63(34.2)	56(30.4)	31(16.8)		184(100.00)

因素	OS				PFS				LRFS				DMFS
因素	HR值	95%CI	P值		HR值	95%CI	P值		HR值	95%CI	P值		HR值	95%CI	P值
年龄(岁)
<53	参照	-	-	参照		-	-	参照		-	-	参照		-	-
≥53	2.70	1.53~4.76	0.001	2.72		1.46~5.08	0.002	5.87		1.62~21.27	0.007	2.40		1.22~4.72	0.011
性别
男	参照	-	-	参照		-	-	参照		-	-	参照		-	-
女	1.30	0.71~2.40	0.399	1.30		0.67~2.52	0.442	2.06		0.63~6.71	0.233	1.32		0.64~2.69	0.454
T分期			0.013				0.031				0.351				0.059
T₁	参照	-	-	参照		-	-	-		-	-	参照		-	-
T₂	2.35	0.82~6.72	0.111	6.75		1.48~30.76	0.014	0.15		0.02~1.34	0.089	6.71		1.47~30.60	0.014
T₃	5.76	1.95~17.06	0.002	10.11		2.17~47.05	0.003	1.40		0.32~6.09	0.656	7.27		1.50~35.27	0.014
T₄	2.63	0.99~6.99	0.052	6.04		1.39~26.37	0.017	参照		-	-	4.39		0.99~19.40	0.051
N分期			0.031				0.430				0.917				0.383
N₀	参照	-	-	参照		-	-	参照		-	-	参照		-	-
N₁	4.71	1.00~22.15	0.050	1.33		0.33~5.30	0.688	0.85		0.11~6.78	0.875	1.24		0.24~6.43	0.796
N₂	5.31	1.12~25.22	0.036	1.69		0.43~6.59	0.454	1.28		0.17~9.97	0.813	1.74		0.35~8.71	0.500
N₃	9.07	1.89~43.54	0.006	2.41		0.60~9.68	0.214	1.43		0.13~15.40	0.767	2.53		0.50~12.90	0.263
因素	OS				PFS				LRFS				DMFS
因素	HR值	95%CI	P值		HR值	95%CI	P值		HR值	95%CI	P值		HR值	95%CI	P值
治疗方案			0.028				0.600				0.285				0.681
单纯放疗	参照	-	-	参照		-	-	参照		-	-	参照		-	-
同步放化疗	0.55	0.30~1.03	0.063	0.86		0.42~1.74	0.674	0.97		0.29~3.28	0.956	1.11		0.51~2.41	0.798
非同步放化疗	0.43	0.22~0.84	0.013	0.68		0.33~1.43	0.313	0.28		0.05~1.52	0.140	0.78		0.34~1.79	0.564
病理类型
角化型鳞状细胞癌	参照	-	-	参照		-	-	参照		-	-	参照		-	-
非角化鳞状细胞癌	0.85	0.40~1.80	0.675	0.98		0.42~2.25	0.955	0.80		0.20~3.22	0.756	1.37		0.47~3.97	0.565

因素	OS				PFS				LRFS				DMFS
因素	HR值	95%CI	P值		HR值	95%CI	P值		HR值	95%CI	P值		HR值	95%CI	P值
年龄(岁)
<53	参照	-	-	参照		-	-	参照		-	-	参照		-	-
≥53	2.74	1.55~4.84	0.001	2.94		1.57~5.52	0.001	6.02		1.61~22.49	0.008	2.63		1.34~5.18	0.005
性别
男	参照	-	-	参照		-	-	参照		-	-	参照		-	-
女	1.24	0.68~2.28	0.484	1.28		0.66~2.47	0.471	1.75		0.52~5.90	0.367	1.31		0.64~2.67	0.463
T分期			0.026				0.012				0.167				0.052
T₁	参照	-	-	参照		-	-	-		-	-	参照		-	-
T₂	2.18	0.81~5.89	0.125	5.11		1.16~22.52	0.031	0.37		0.07~2.08	0.259	4.33		0.97~19.27	0.055
T₃	4.25	1.53~11.83	0.006	10.11		2.22~44.28	0.003	2.08		0.50~8.70	0.314	6.73		1.47~30.77	0.014
T₄	3.58	1.22~10.52	0.020	6.04		1.95~42.44	0.005	参照		-	-	7.80		1.65~36.89	0.010
N分期			0.028				0.443				0.972				0.393
N₀	参照	-	-	参照		-	-	参照		-	-	参照		-	-
N₁	3.75	0.82~17.17	0.089	1.37		0.35~5.29	0.652	0.94		0.12~7.17	0.953	1.28		0.26~6.40	0.763
N₂	3.91	0.85~17.91	0.079	1.47		0.40~5.47	0.565	1.28		0.19~8.60	0.797	1.50		0.31~7.20	0.612
N₃	7.92	1.67~37.58	0.009	2.39		0.61~9.40	0.212	1.23		0.13~11.58	0.859	2.54		0.51~12.71	0.256
治疗方案			0.054				0.801				0.603				0.928
单纯放疗	参照	-	-	参照		-	-	参照		-	-	参照		-	-
同步放化疗	0.53	0.28~1.00	0.051	0.82		0.41~1.67	0.589	0.96		0.27~3.43	0.954	1.04		0.48~2.25	0.929
非同步放化疗	0.49	0.25~0.96	0.039	0.79		0.37~1.69	0.544	0.44		0.08~2.42	0.346	0.89		0.38~2.08	0.789
病理类型
角化型鳞状细胞癌	参照	-	-	参照		-	-	参照		-	-	参照		-	-
非角化鳞状细胞癌	0.88	0.42~1.88	0.748	1.10		0.47~2.55	0.827	1.01		0.25~4.14	0.991	1.54		0.53~4.48	0.429

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