ImportanceAccurate staging is a fundamental step in treating patients with nasopharyngeal carcinoma (NPC) worldwide; this is crucial not only for prognostication, but also for guiding treatment decisions. The American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) tumor-node-metastasis (TNM) system is the global language for clinicians, researchers, and cancer registries. Continual improvement that aligns with contemporary pattern of care is essential.ObjectiveTo improve the prognostic accuracy and clinical applicability of the eighth edition (TNM-8) for NPC.Design, Setting, and ParticipantsThis multicenter study analyzed patients with NPC with detailed tumor features during January 2014 and December 2015 and was reviewed by experienced radiologists. The data analysis was completed in December 2023. The findings were further confirmed with internal and external validation. Statistical analyses and clinical considerations were reviewed by the AJCC/UICC multidisciplinary head and neck panels and attained consensus. The recommendations were evaluated by the AJCC Evidence-Based Medicine Committee before final endorsement as the ninth version (TNM-9).Main Outcomes and MeasuresThe primary end point was overall survival. Adjusted hazard ratios of different subgroups were then assessed for confirmation of optimal stage grouping.ResultsOf the 4914 patients analyzed, 1264 (25.7%) were female and 3650 (74.3%) were male; the median (SD) age was 48.1 (12.0) years. Advanced radiological extranodal extension (with involvement of adjacent muscles, skin, and/or neurovascular bundles) was identified as an independent adverse factor for all end points: this was added as a criterion for N3. Patients with nonmetastatic disease were regrouped into stages I to III instead of TNM-8 stages I to IVA. Significant hazard discrimination was achieved by grouping T1-2N0-1 as stage I, T3/N2 as stage II, and T4/N3 as stage III. Although the T1-2N0-1 subgroups had comparable 5-year overall survival, subdivisions into IA (T1-T2N0) and IB (T1-T2N1) were recommended due to the distinction in adjusted hazard ratios following adjustment for chemotherapy use. Metastatic disease was exclusively classified as stage IV, and prognostication was further refined by subdivision into IVA (M1a, ≤3 lesions) and IVB (M1b, >3 lesions). TNM-9 demonstrated superiority compared with TNM-8 in major statistical aspects.Conclusion and RelevanceThe results of this diagnostic study suggest that the ninth version of TNM staging for NPC, based on robust analyses and a comprehensive review by the AJCC/UICC staging committees, provides an improved staging system for global application and a framework for future incorporation of nonanatomical factors. This will be launched for global application in January 2025.

中文翻译：

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AJCC 和 UICC 鼻咽癌 TNM 分期分类第九版


重要性准确分期是治疗全球鼻咽癌 （NPC） 患者的基本步骤;这不仅对预后至关重要，而且对指导治疗决策也至关重要。美国癌症联合委员会 （AJCC）/国际癌症控制联盟 （UICC） 肿瘤-淋巴结转移 （TNM） 系统是临床医生、研究人员和癌症登记处的全球语言。与现代护理模式相一致的持续改进至关重要。目的提高第八版 （TNM-8） 对 NPC.Design、环境和参与者的预后准确性和临床适用性这项多中心研究分析了 2014 年 1 月至 2015 年 12 月期间具有详细肿瘤特征的 NPC 患者，并由经验丰富的放射科医生进行审查。数据分析于 2023 年 12 月完成。内部和外部验证进一步证实了这些发现。AJCC/UICC 多学科头颈部小组对统计分析和临床考虑进行了审查并达成共识。这些建议由 AJCC 循证医学委员会进行评估，然后最终认可为第九版 （TNM-9）。主要结局和测量主要终点是总生存期。然后评估不同亚组的调整后风险比以确认最佳分期分组。结果在分析的 4914 例患者中，女性 1264 例 （25.7%） ，男性 3650 例 （74.3%）;中位 （SD） 年龄为 48.1 （12.0） 岁。晚期放射学结外扩展 （累及相邻肌肉、皮肤和/或神经血管束） 被确定为所有终点的独立不利因素：这被添加为 N3 的标准。 非转移性疾病患者被重新分为 I 至 III 期，而不是 TNM-8 I 至 IVA 期。通过将 T1-2N0-1 归类为 I 期，T3/N2 归类为 II 期，T4/N3 归类为 III 期，可实现显著的危险鉴别。尽管 T1-2N0-1 亚组具有相当的 5 年总生存期，但由于调整化疗使用后调整后风险比存在差异，因此建议细分为 IA （T1-T2N0） 和 IB （T1-T2N1）。转移性疾病仅归类为 IV 期，通过将 IVA（M1a，≤3 个病灶）和 IVB（M1b，>3 个病灶）。与 TNM-8 相比，TNM-9 在主要统计方面表现出优越性。结论和相关性这项诊断研究的结果表明，基于 AJCC/UICC 分期委员会的稳健分析和全面审查，NPC TNM 分期的第九版为整体应用提供了改进的分期系统，并为未来纳入非解剖因素提供了框架。该计划将于 2025 年 1 月推出全球应用。