Validation of T classifications in the 7th edition UICC staging system and recommendation of a simplified T classifications based on intensity-modulated radiotherapy

黄　爽; 姜　锋; 陈媛媛

doi:10.19401/j.cnki.1007-3639.2016.12.008

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Validation of T classifications in the 7th edition UICC staging system and recommendation of a simplified T classifications based on intensity-modulated radiotherapy

更新时间：2025-12-31

- Validation of T classifications in the 7th edition UICC staging system and recommendation of a simplified T classifications based on intensity-modulated radiotherapy
- China Oncology Vol. 26, Issue 12, Pages: 1012-1017(2016)
- 作者机构：
  
  浙江省肿瘤医院放疗科,浙江,杭州,310022
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2016.12.008
  CLC：
- Published Online：23 January 2017，
  
  Published：23 January 2016
- 稿件说明：
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黄　爽,姜　锋,陈媛媛,等. 基于调强放射治疗的鼻咽癌UICC第7版T分期验证及简化推荐[J]. 中国癌症杂志, 2016, 26(12): 1012-1017.

黄　爽, 姜　锋, 陈媛媛. Validation of T classifications in the 7th edition UICC staging system and recommendation of a simplified T classifications based on intensity-modulated radiotherapy[J]. China Oncology, 2016, 26(12): 1012-1017.
黄　爽,姜　锋,陈媛媛,等. 基于调强放射治疗的鼻咽癌UICC第7版T分期验证及简化推荐[J]. 中国癌症杂志, 2016, 26(12): 1012-1017. DOI： 10.19401/j.cnki.1007-3639.2016.12.008.

黄　爽, 姜　锋, 陈媛媛. Validation of T classifications in the 7th edition UICC staging system and recommendation of a simplified T classifications based on intensity-modulated radiotherapy[J]. China Oncology, 2016, 26(12): 1012-1017. DOI： 10.19401/j.cnki.1007-3639.2016.12.008.

摘要

背景与目的：调强放射治疗可以明显提高鼻咽癌的局部控制率，使T分期的预后价值发生改变。本文拟评价接受调强放射治疗的鼻咽癌患者国际抗癌联盟(Union for International Cancer Control，UICC)第7版分期中T分期的预后价值，并对其简化方式进行探讨。方法：回顾浙江省肿瘤医院放疗科2007年1月—2011年6月收治的641例初治鼻咽癌患者的基本资料，采用Kaplan-Meier法及COX回归评价UICC第7版分期中T分期的预后价值。结果：641例患者的5年总生存率(overall survival，OS)、无局部复发生存率(loco-relapse free survival，LRFS)、无进展生存率(progression-free survival，PFS)和无远处转移生存率(distant metastasis free survival，DMFS)分别为85.4%、88.5%、78%和87.1%，其中T

、T

和T

分期患者的5年OS分别为91.6%、85.3%、90.1%和76.5%，LRFS为93%、85.3%、91.5%和84.4%，PFS为88.2%、77.3%、80.8%和70.9%，DMFS为95.1%、88.9%、88.2%和81.3%。其中T

、T

和T

期的各指标间差异无统计学意义，而T

期与T

、T

和T

期之间多个预后指标差异均有统计学意义(P0.05)。将T

、T

和T

期合并为新T

期，T

期为新T

期。新T

和T

期的5年OS为89.1%和76.5%(P=0.001)；LRFS为90.1%和84.4%(P=0.028)；PFS为81%和70.9%(P=0.001)；DMFS为90.8%和81.2%(P=0.002)，差异均有统计学意义。在不同的N分期中分别分析，简化的T分期仍有明显的预后预测优势。结论：在调强放射治疗时代，UICC第7版分期中的T分期之间的预后差异不明显，简化T分期能更好地适应治疗方法的改革和预测预后。

Abstract

Background and purpose: The application of intensity-modulated radiothera

py (IMRT) has improved the local control rate of nasopharyngeal carcinoma greatly

which changed the predictive value of T classifications of TNM staging system. This study aimed to validate the predictive effect of T classifications in the 7th Union for International Cancer Control (UICC) staging system and discuss the simplification of T classifications. Methods: We retrospectively reviewed the clinical data of 641 primary nasopharyngeal carcinoma patients at our center from January 2007 to June 2011. We evaluated the predictive effect of T classifications by Kaplan-Meier method and Cox regression model. Results: The 5-year overall survival (OS)

local relapse-free survival (LRFS)

progression-free survival (PFS) and distant metastasis free survival (DMFS) were 85.4%

88.5%

78% and 87.1%

respectively. The 5-year OS of T

and T

categories were 91.6%

85.3%

90.1% and 76.5%

respectively; LRFS were 93%

85.3%

91.5% and 84.4%; PFS were 88.2%

77.3%

80.8% and 70.9%; DMFS were 95.1%

88.9%

88.2% and 81.3%

respectively. The difference in survival curves between T

and T

were not significant (P0.05). However

several prognostic indexes were significantly different between T

and T

. We merged the T

and T

classifications as new T

and the T

classification as new T

. The 5-year OS of new T

and T

were 89.1% and 76.5% (P=0.001); LRFS were 90.1% and 84.4% (P=0.028); PFS were 81% and 70.9% (P=0.001); DMFS were 90.8% and 81.2% (P=0.002). The survival curves were substantially separated. The simplified T classifications had obvious advantages when separately analyzed in different N stages. Conclusion: In the era of IMRT

the predictive effect of T classifications of the 7th UICC staging system has diminished. The simplification of T classifications can fit with the new treatment and

provide a better survival prediction.

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