Subdivision of M category for nasopharyngeal carcinoma with synchronous metastasis:time to expand the M categorization system  

作　　者：Lu-Jun Shen Si-Yang Wang Guo-Feng Xie Qi Zeng Chen Chen An-Nan Dong Zhi-Mei Huang Chang-Chuan Pan Yun-Fei Xia Pei-Hong Wu 

机构地区：[1]Department of Medical Imaging and Interventional Radiology,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine [2]Department of Radiation Oncology,The Fifth Affiliated Hospital of Sun Yat-sen University [3]Department of Radiation Oncology,Cancer Center of Guangzhou Medical University [4]Department of Radiation Oncology,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine [5]Department of Medical Oncology,Sichuan Cancer Hospital and Institute

出　　处：《Chinese Journal of Cancer》2015年第10期450-483,共34页

基　　金：supported by the Grant from National High Technology Research and Development Program of China(863 Program)(No.2012AA022701)

摘　　要：Introduction:The current metastatic category(M) of nasopharyngeal carcinoma(NPC) is a "catch-all" classification,covering a heterogeneous group of tumors ranging from potentially curable to incurable.The aim of this study was to design an M categorization system that could be applied in planning the treatment of NPC with synchronous metastasis.Methods:A total of 505 NPC patients diagnosed with synchronous metastasis at Sun Yat-sen University Cancer Center between 2000 and 2009 were involved.The associations of clinical variables,metastatic features,and a proposed M categorization system with overall survival(OS) were determined by using Cox regression model.Results:Multivariate analysis showed that Union for International Cancer Control(UICC) N category(N1-3/N0),number of metastatic lesions(multiple/single),liver involvement(yes/no),radiotherapy to primary tumor(yes/no),and cycles of chemotherapy(>4/<4) were independent prognostic factors for OS.We defined the following subcategories based on liver involvement and the number of metastatic lesions:Mia,single lesion confined to an isolated organ or location except the liver;Ml b,single lesion in the liver and/or multiple lesions in any organs or locations except the liver;and M1 c,multiple lesions in the liver.Of the 505 cases,74(14.7%) were classified as Mia,296(58.6%)as M1 b,134(26.5%) as M1 c,and 1 was not specified.The three Ml subcategories showed significant difference in OS[Ml b vs.Mia,hazard ratio(HR) = 1.69,95%confidence interval(CI) = 1.16-2.48,P = 0.007;Ml c vs.Ml a,HR = 2.64,95%CI = 1.75-3.98,P< 0.001],Conclusions:We developed an M categorization system based on the independent factors related to the prognosis of patients with metastatic NPC.This system may be helpful to further optimize individualized care for NPC patients.Introduction:The current metastatic category(M) of nasopharyngeal carcinoma(NPC) is a 'catch-all' classification,covering a heterogeneous group of tumors ranging from potentially curable to incurable.The aim of this study was to design an M categorization system that could be applied in planning the treatment of NPC with synchronous metastasis.Methods:A total of 505 NPC patients diagnosed with synchronous metastasis at Sun Yat-sen University Cancer Center between 2000 and 2009 were involved.The associations of clinical variables,metastatic features,and a proposed M categorization system with overall survival(OS) were determined by using Cox regression model.Results:Multivariate analysis showed that Union for International Cancer Control(UICC) N category(N1-3/N0),number of metastatic lesions(multiple/single),liver involvement(yes/no),radiotherapy to primary tumor(yes/no),and cycles of chemotherapy(>4/<4) were independent prognostic factors for OS.We defined the following subcategories based on liver involvement and the number of metastatic lesions:Mia,single lesion confined to an isolated organ or location except the liver;Ml b,single lesion in the liver and/or multiple lesions in any organs or locations except the liver;and M1 c,multiple lesions in the liver.Of the 505 cases,74(14.7%) were classified as Mia,296(58.6%)as M1 b,134(26.5%) as M1 c,and 1 was not specified.The three Ml subcategories showed significant difference in OS[Ml b vs.Mia,hazard ratio(HR) = 1.69,95%confidence interval(CI) = 1.16-2.48,P = 0.007;Ml c vs.Ml a,HR = 2.64,95%CI = 1.75-3.98,P< 0.001],Conclusions:We developed an M categorization system based on the independent factors related to the prognosis of patients with metastatic NPC.This system may be helpful to further optimize individualized care for NPC patients.

关 键 词：NASOPHARYNGEAL carcinoma  TNM staging  Metastasis  Prognosis 

分 类 号：R739.63[医药卫生—肿瘤]