Refining TNM-8 M1 categories with anatomic subgroups for previously untreated de novo metastatic nasopharyngeal carcinoma. (March 2022)

• Record Type: Journal Article
• Authors: Chan, Sik Kwan; Lin, Cheng; Huang, Shao Hui; Chau, Tin Ching; Guo, Qiao Juan; O'Sullivan, Brian; Lam, Ka On; Chau, Sze Chun; Chan, Sum Yin; Tong, Chi Chung; Vardhanabhuti, Varut; Kwong, Dora Lai Wan; So, Tsz Him; Ng, Chor Yi; Leung, To Wai; Luk, Mai Yee; Lee, Anne Wing Mui; Choi, Horace Cheuk Wai; Pan, Jian Ji; Lee, Victor Ho Fun
• Is Part Of: Oral oncology. Volume 126(2022)
• Publication Date: 2022-03
• Subjects: Nasopharyngeal carcinoma -- Metastatic -- M1 categories -- Recursive partitioning analysis -- TNM; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2022.105736
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: De novo M1 NPC is not further subdivided in the current TNM-8 staging classification. Our two academic institutions share a similar treatment strategy for de novo M1 NPC. Co-existing liver-bone metastases had a worse survival by recursive partitioning analysis. We propose incorporating co-existing liver-bone metastases into future editions of TNM. Abstract: Purpose: To propose a refined M1 classification in de novo metastatic nasopharyngeal carcinoma (NPC) based on pooled data from two academic institutions. Methods: Previously untreated de novo M1 NPC patients prospectively treated at The University of Hong Kong (N = 69) and Fujian Cancer Hospital (N = 114) between 2007 and 2016 were recruited and randomized in a 2:1 ratio to generate training (N = 120) and validation (N = 63) cohorts, respectively. Multivariable analysis (MVA) was performed for the training and validation cohorts to identify anatomic prognostic factors for overall survival (OS). Recursive partitioning analysis (RPA) was performed which incorporated the anatomic prognostic factors identified in the MVA to derive Anatomic-RPA groups which stratified OS in the training cohort, and were then validated in the validation cohort. Results: Median follow-up for the training and validation cohorts was 27.2 and 30.2 months with 3-year OS of 51.6% and 51.1%, respectively. MVA revealed that co-existing liver-bone metastases was the only factor prognostic for OS in both the training and validation cohorts. Anatomic-RPA separated M1 disease into M1a (no co-existing liver-bone metastases) and M1b (co-existing liver-bone metastases) with median OS 39.5 and 23.7 months, respectively (p = 0.004) in the training cohort. RPA for the validation cohort also confirmed good segregation with co-existing liver-bone metastases with median OS 47.7 and 16.0 months, respectively (p = 0.008). Conclusion: Our proposal to subdivide de novo M1 NPC into M1a (no co-existing liver-bone metastases) vs. M1b (co-existing liver-bone metastases) provides better OS segregation.