Refining the 8th edition TNM classification for EBV related nasopharyngeal carcinoma.

IF 48.8 1区医学 Q1 CELL BIOLOGY

Cancer Cell Pub Date : 2024-03-11 Epub Date: 2024-01-18 DOI:10.1016/j.ccell.2023.12.020

Xiao-Jing Du, Gao-Yuan Wang, Xiao-Dong Zhu, Ya-Qian Han, Feng Lei, Liang-Fang Shen, Kun-Yu Yang, Lei Chen, Yan-Ping Mao, Ling-Long Tang, Ling Li, Zheng Wu, Gui-Qiong Xu, Qin Zhou, Jing Huang, Rui Guo, Yuan Zhang, Xu Liu, Guan-Qun Zhou, Wen-Fei Li, Cheng Xu, Li Lin, Yu-Pei Chen, Fo-Ping Chen, Xiao-Yu Liang, Si-Yuan Chen, Shu-Qi Li, Chun-Yan Cui, Ji-Bin Li, Jian Ren, Ming-Yuan Chen, Li-Zhi Liu, Ying Sun, Jun Ma

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Abstract

The AJCC/UICC TNM classification describes anatomic extent of tumor progression and guides treatment decisions. Our comprehensive analysis of 8,834 newly diagnosed patients with non-metastatic Epstein-Barr virus related nasopharyngeal carcinoma (NPC) from six Chinese centers indicates certain limitations in the current staging system. The 8th edition of the AJCC/UICC TNM classification inadequately differentiates patient outcomes, particularly between T2 and T3 categories and within the N classification. We propose reclassifying cases of T3 NPC with early skull-base invasion as T2, and elevating N1-N2 cases with grade 3 image-identified extranodal extension (ENE) to N3. Additionally, we suggest combining T2N0 with T1N0 into a single stage IA. For de novo metastatic (M1) NPC, we propose subdivisions of M1a, defined by 1-3 metastatic lesions without liver involvement, and M1b, characterized by >3 metastatic lesions or liver involvement. This proposal better reflects responses of NPC patients to the up-to-date treatments and their evolving risk profiles.

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完善第 8 版 TNM 分类法中与 EBV 相关的鼻咽癌。

AJCC/UICC TNM 分级描述了肿瘤进展的解剖范围，并为治疗决策提供指导。我们对来自中国六个中心的8834名新确诊的与爱泼斯坦-巴氏病毒相关的非转移性鼻咽癌（NPC）患者进行了全面分析，结果表明目前的分期系统存在一定的局限性。第 8 版 AJCC/UICC TNM 分期对患者的预后区分不足，尤其是在 T2 和 T3 类别之间以及 N 分类内部。我们建议将有早期颅底侵犯的 T3 型鼻咽癌病例重新分类为 T2 型，并将有 3 级影像确定的结节外扩展（ENE）的 N1-N2 型病例提升为 N3 型。此外，我们还建议将 T2N0 和 T1N0 合并为单一的 IA 分期。对于新发转移性（M1）鼻咽癌，我们建议将其细分为 M1a 和 M1b，M1a 的定义是 1-3 个转移病灶且未累及肝脏，M1b 的特征是 >3 个转移病灶或累及肝脏。这一建议更好地反映了鼻咽癌患者对最新治疗方法的反应及其不断变化的风险特征。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Cell 医学-肿瘤学

CiteScore

55.20

自引率

1.20%

发文量

179

审稿时长

4-8 weeks

期刊介绍： Cancer Cell is a journal that focuses on promoting major advances in cancer research and oncology. The primary criteria for considering manuscripts are as follows: Major advances: Manuscripts should provide significant advancements in answering important questions related to naturally occurring cancers. Translational research: The journal welcomes translational research, which involves the application of basic scientific findings to human health and clinical practice. Clinical investigations: Cancer Cell is interested in publishing clinical investigations that contribute to establishing new paradigms in the treatment, diagnosis, or prevention of cancers. Insights into cancer biology: The journal values clinical investigations that provide important insights into cancer biology beyond what has been revealed by preclinical studies. Mechanism-based proof-of-principle studies: Cancer Cell encourages the publication of mechanism-based proof-of-principle clinical studies, which demonstrate the feasibility of a specific therapeutic approach or diagnostic test.