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Objectives <p>To evaluate the prognostic accuracy and clinical applicability of the ninth edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) tumor-node-metastasis (TNM) staging system for non-metastatic nasopharyngeal carcinoma (NPC) in the era of [<sup>18</sup>F]-fluorodeoxyglucose ([<sup>18</sup>F] FDG) positron emission tomography (PET)/computed tomography (CT).</p> Materials and methods <p>This retrospective study included 301 patients with NPC treated by intensity-modulated radiotherapy at a tertiary academic cancer center from January 1, 2003, to February 28, 2023. The comparison between the ninth edition of the AJCC/UICC TNM (TNM-9) and the eighth edition of the AJCC/UICC TNM (TNM-8) staging systems was performed. The primary endpoint was overall survival (OS).</p> Results <p>The proportions of patients receiving [<sup>18</sup>F] FDG PET/CT and magnetic resonance imaging as initial workup were 99.3% (299/301) and 96.9% (289/301), respectively. The median follow-up time was 88.1 months (interquartile range (IQR), 51.1–136.8 months). Based on the TNM-9 staging system, the 5-year OS rates of patients with Stage I, II and III were 91.7%, 84.8% and 76.8%, respectively (<i>p</i> = 0.090). The 5-year OS rates of patients with classification N0, N1, N2, and N3 were 92.0%, 87.1%, 77.6% and 79.1%, respectively (<i>p</i> = 0.879). The area under the receiver-operator characteristic curve values of the TNM-9 and TNM-8 were 0.6239 and 0.6678 for OS (<i>p</i> = 0.0003), respectively.</p> Conclusion <p>The TNM-9 staging system did not exhibit strong overall discrimination between the stage-group classifications for OS of non-metastatic NPC in the [<sup>18</sup>F]FDG PET era.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis><i> Does the newly launched TNM-9 staging system (January 2025) remain valid for non-metastatic NPC in the era of [</i><sup><i>18</i></sup><i>F] FDG PET/CT?</i></p> <p><Emphasis Type="BoldItalic">Findings</Emphasis><i> The TNM-9 staging system showed declining 5-year overall survival rates from Stage I to III, with modest overall predictive accuracy for overall survival</i>.</p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis><i> These findings suggest that the TNM-9 staging system has a limited ability to discriminate overall survival between stage groups in non-metastatic NPC in the [</i><sup><i>18</i></sup><i>F] FDG PET/CT era</i>.</p> Graphical Abstract <p></p>

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Staging of non-metastatic nasopharyngeal carcinoma with PET/CT

  • 期刊论文

  • 发表日期：

    2026年4月20日

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  • Caineng Cao,
  • Teeradon Treechairusame,
  • Yingzhi Wu,
  • Achraf Shamseddine,
  • Yao Yu,
  • Nadeem Riaz,
  • Daphna Y. Gelblum,
  • Sean M. McBride,
  • Jung Julie Kang,
  • Kaveh Julie Zakeri,
  • Chiaojung Jillian Tsai,
  • Richard J. Wong,
  • Jennifer R. Cracchiolo,
  • Marc A. Cohen,
  • Ian A. Ganly,
  • Jatin P. Shah,
  • Alan L. Ho,
  • Winston L. Wong,
  • Lara A. Dunn,
  • Loren Scott Michel,
  • Eric J. Sherman,
  • Nancy Y. Lee

摘要

Objectives

To evaluate the prognostic accuracy and clinical applicability of the ninth edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) tumor-node-metastasis (TNM) staging system for non-metastatic nasopharyngeal carcinoma (NPC) in the era of [18F]-fluorodeoxyglucose ([18F] FDG) positron emission tomography (PET)/computed tomography (CT).

Materials and methods

This retrospective study included 301 patients with NPC treated by intensity-modulated radiotherapy at a tertiary academic cancer center from January 1, 2003, to February 28, 2023. The comparison between the ninth edition of the AJCC/UICC TNM (TNM-9) and the eighth edition of the AJCC/UICC TNM (TNM-8) staging systems was performed. The primary endpoint was overall survival (OS).

Results

The proportions of patients receiving [18F] FDG PET/CT and magnetic resonance imaging as initial workup were 99.3% (299/301) and 96.9% (289/301), respectively. The median follow-up time was 88.1 months (interquartile range (IQR), 51.1–136.8 months). Based on the TNM-9 staging system, the 5-year OS rates of patients with Stage I, II and III were 91.7%, 84.8% and 76.8%, respectively (p = 0.090). The 5-year OS rates of patients with classification N0, N1, N2, and N3 were 92.0%, 87.1%, 77.6% and 79.1%, respectively (p = 0.879). The area under the receiver-operator characteristic curve values of the TNM-9 and TNM-8 were 0.6239 and 0.6678 for OS (p = 0.0003), respectively.

Conclusion

The TNM-9 staging system did not exhibit strong overall discrimination between the stage-group classifications for OS of non-metastatic NPC in the [18F]FDG PET era.

Key Points

Question Does the newly launched TNM-9 staging system (January 2025) remain valid for non-metastatic NPC in the era of [18F] FDG PET/CT?

Findings The TNM-9 staging system showed declining 5-year overall survival rates from Stage I to III, with modest overall predictive accuracy for overall survival.

Clinical relevance These findings suggest that the TNM-9 staging system has a limited ability to discriminate overall survival between stage groups in non-metastatic NPC in the [18F] FDG PET/CT era.

Graphical Abstract