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Staging of nasopharyngeal carcinoma: From Ho's to the new UICC system
Author(s) -
Lee Anne W.M.,
Foo William,
Law Stephen C.K.,
Poon Y.F.,
O S.K.,
Tung Stewart Y.,
Sze W.M.,
Chappell Rick,
Lau W.H.,
Ho John H.C.
Publication year - 1999
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/(sici)1097-0215(19990420)84:2<179::aid-ijc15>3.0.co;2-6
Subject(s) - nasopharyngeal carcinoma , medicine , statistical significance , skull , laterality , carcinoma , esthesioneuroblastoma , t stage , surgery , radiation therapy , overall survival , audiology
The independent significance of different tumor factors in 4,514 patients with undifferentiated or non‐keratinizing carcinoma of the nasopharynx irradiated at the Queen Elizabeth Hospital during 1976–1985 were analyzed retrospectively. Multivariate analyses showed that the most significant primary factors included cranial nerve palsy, erosion of base of skull and oropharynx. For tumors within the nasopharynx, there was no difference in survival between those with involvement of 1 site vs. more than 1 sites. Patients with cranial nerve palsy had significantly worse prognosis than those with bony erosion alone. Although the nodal characteristics (size, level of extension, fixation, laterality and multiplicity) were inter‐related, their independent impact all reached statistical significance. However, the criteria used currently could be simplified: laterality should be revised to unilateral vs. bilateral, level to upper‐mid vs. lower neck, and size to ≤6 cm vs. >6 cm. Grouping of N2 together with N3 into Stage IV was inappropriate as the former had significantly better prognosis. Our findings, together with review of the publications, provided clinical data for developing the current UICC staging system for nasopharyngeal carcinoma. Such major revision resulted not only in better distinction of hazards, but also more even distribution of cases between different stages. Int. J. Cancer (Pred. Oncol.): 84:179–187, 1999. © 1999 Wiley‐Liss, Inc.