摘要
目的准确的分期系统对癌症的治疗至关重要。随着癌症分期和治疗方法的演变，需要不断评价分期的适用性和改进性。方法基于第7版AJCC／UICC分期回顾性分析香港和中国大陆2个肿瘤中心收治的1609例接受调强放射治疗的首诊无转移鼻咽癌患者临床资料，所有患者治疗前均行核磁共振分期评估。结果无其他T3、T4期解剖结构受侵患者中，伴有咀嚼肌间隙（翼内肌和／或翼外肌）侵犯、椎前肌侵犯及咽旁间隙侵犯的三组患者之间0s相近。伴广泛软组织（上述侵犯结构以外的软组织）受侵患者OS与伴有颅内侵犯或颅神经侵犯相似。仅2％患者锁骨上窝以上淋巴结转移者直径〉6cm，其0s率与下颈淋巴结转移者类似。用下颈（环状软骨尾侧缘水平以下）代替锁骨上窝并不影响N分期之间的风险差异性。采用推荐的T、N分期，T。N。、T。N，期0s相近。结论经AJCC／UICC分期筹备委员会审阅后，建议第8版分期应将翼内肌／翼外肌从T。降到T：期，增加椎前肌为L期，用下颈取代锁骨上窝，将淋巴结最大直径〉6cm合并归为N，期，将T。、N，期统一归为Ⅳ。期。这些改变不仅使得相邻分期间风险差异性更好，而且使得临床实践性与全球适用性之间达到最佳平衡。
Objective An accurate staging system is crucial for cancer management. With the development of cancer staging systems and therapeutic methods, the applicability and improvement of staging systems should be evaluated constantly. Methods The clinical data of 1 609 nasopharyngeal carcinoma patients without metastasis at initial diagnosis, who were admitted to two tumor centers in Hong Kong and China's Mainland and received intensity-modulated radiotherapy （IMRT） , were analyzed retrospectively based on the 7th edition of the American Joint Committee on Cancer （AJCC） or International Union Against Cancer （UICC） staging system, and all the patients underwent magnetic resonance imaging （MRI） before treatment. Results Among the T3/T4 patients without involvement of other anatomic structures, overall survival （OS） showed no significant differences between the patients with masticator space （medial pterygoid muscle and/or lateral pterygoid muscle） involvement, prevertebral muscle involvement, and parapharyngeal space involvement. The OS was similar between the patients with extensive soft tissue （ soft tissues other than the structures mentioned above ） involvement and those with intraeranial involvement or cranial nerve involvement. Only 2% of the patients had lymph node metastasis 〉 6 cm above the supraelavicular fossa （ SCF）, with an OS similar to that of the patients with lower cervical lymph node metastasis. Replacing SCF with the lower neck （below the caudal border of the cricoid cartilage ） did not affect the risk difference between different N stages. With the proposed T and N staging systems, the OS showed no significant differences between T4N0.2 and TI_4N3 patients. Conclusions After a review by AJCC/UICC staging system preparatory committees, the changes recommended for the 8＇h edition include changing medial pterygoid muscle or lateral pterygoid muscle involvement from T4 to T：, adding prevertebral muscle involvement to T2 stage, replacing SCF with the lower neck and combining this with a maximum lymph node diameter of〉6 cm as N3 stage, and integrating T4 and N3 as stage [ VA. These changes result in a better risk difference between adjacent stages and achieve the optimal balance between clinical practicability and global applicability.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2016年第3期197-206,共10页
Chinese Journal of Radiation Oncology
关键词
鼻咽肿瘤/放射疗法
预后
TNM分期
Nasopharyngeal neoplasms/radiotherapy
Prognosis
TNM staging system
