ArticleClinical and translational radiation oncology2027
Validation and refinement of the N classification for nasopharyngeal carcinoma based on the 9th version AJCC/UICC TNM staging system in non-endemic regions of China: a multicenter cohort study.
Article in Clinical and translational radiation oncology, 2027. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The applicability of the ninth version AJCC/UICC N classification for nasopharyngeal carcinoma (NPC) in non-endemic regions remains uncertain, particularly regarding the incorporation of advanced extranodal extension (ENE) into the N3 category. We conducted a retrospective multicenter study including 1356 patients with NPC treated between 2011 and 2021 in eastern China. All patients were staged according to both the eighth and ninth version systems. Survival outcomes, including overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and regional recurrence-free survival (RRFS), were analyzed using Kaplan-Meier and Cox regression methods. Model performance was evaluated using the concordance index (C-index) and Akaike information criterion (AIC). Under the ninth version, 136 patients with advanced ENE were upstaged from N1-N2 to N3, resulting in clearer separation between N3 and N0-N2 groups across all endpoints. No statistically significant differences in survival outcomes were observed between patients upstaged to N3 and those with conventional N3 disease. The ninth version showed statistically significant but small increases in C-index compared with the eighth version. However, time-dependent AUC differences varied across survival endpoints and follow-up time points. Within the N3 subgroup, advanced ENE was associated with significantly worse OS, PFS, and DMFS, and remained an independent predictor of OS (HR 1.78,
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