| Objective To investigate the rationality of the staging systems of nasopharyngeal carcinoma and provide the basis for improving by retrospectively analyzing the clinical data of 122 initially treated patients and re-staging according to Chinese 92 staging system,08 staging system,the 6th edition UICC/AJCC staging system and the 7th edition staging system.Methods From January 2004 to January 2009,122 case, pathologically proved and newly diagnosed as metastasis-free NPC patients who hospitalized to affiliated tumor hospital of Guang Xi Medical university, were collected. And all of them were performed detailed medical examination, MRI scan of nasopharynx and neck, nasopharynx fiberscopes inspection, nasopharynx tumor biopsies and pathological examination and other relevant examinations before treatment. The invasion status of anatomic structures related to standards of Chinese 92 staging system,08 staging system, the 6th edition UICC/AJCC staging system and the 7th edition staging system were marked by reading the CT and MRI. Then the T staging, N staging and clinical staging were recorded according to the four staging systems respectively and the case distribution of different stages were compared. Further more, the T staging of 2008 staging system was validated according to comparision of the T staging factors and the survival curves of different T staging systems.Results The follow-up rate was 95.3%. Cases of disease failure were 20, including 6 cases of single recurrence,2 cases of single transfer,2 cases of both recurrence and metastasis and 10 cases of death. The overall survival rates of 1-years,2-years,3-years were 100%,95%,87%, respectively. For the'92 staging and 2008 staging, there were statistical differences in the population distribution of N stagings (P=0.0001). However, there were no statistical differences in the population distribution of T stagings (P=0.957). For the 2008 staging and 2010 staging,there were no statistically significant in the population distribution of both T and N stagings (P=0.995 and 0.595). Involvement of oropharynx, soft palatine, prior-styloid space, pterygopalatine fossa were 100% accompanied with other same or more advanced T-stage classifications according to 92'staging system. Involvement of nasal cavity, pre-styloid space, prevertebral muscles were only a little (both <3%) not accompanied with other same or more advanced T-stage classifications. Further more, involvement of medial pterygoid muscle were 100% accompanied with other same or more advanced T-stage classifications according to the 2008 staging system. Last, Cox regression method for survival analysis of T staging indicated that there were cross and overlap in the survival curves of the T2 and T3 stagings of 92'staging, 2002 staging,2010 staging and the curves didn't segregate obviously, However, the survival curves of 2008 staging seemed to segregate better.Conclusion 1. For 2008 staging, changes of the population distribution of the N staging were obvious and it seems more reasonable compared with'92 staging. For the T staging, the population distribution is more close and similar to 2010 staging.2. For the Chinese staging system, the simplification of pterygopalatine fossa, soft palate, cervical vertebra, orbit, and the merger of Pre-styloid space and carotid sheath area for parapharyngeal space seems reasonable. It is also recommended that oropharyngeal should be deleted in the 2008 staging system. Additionally, the rationality of splitting the anatomic structure of massetricspace should be verified further.3. T stage of 2008 staging seems more reasonable than other three kinds of staging system based on survival curves. However, because of the limit of the small sample and short-tern follow-up, the result still need to be verified by large sample and long-term follow-up of multi-center studies. |
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