Extent of paranasal sinus involvement and its prognostic value in nasopharyngeal carcinoma: Proposed modification in the current UICC/AJCC staging system. (July 2021)

• Record Type: Journal Article
• Authors: Wang, Xiao-Yi; Zhu, Si-Yu; WU, Wei-Jie; Li, Hao-Jiang; Li, Jiao; Lin, Xiao-Feng; Li, Li; Liu, Li-Zhi
• Is Part Of: Radiotherapy and oncology. Volume 160(2021)
• Page Start: 221
• Page End: 227
• Publication Date: 2021-07
• Subjects: DMFS Distant metastasis–free survival -- IMRT intensity modulated radiation therapy -- NPC nasopharyngeal carcinoma -- LRFS loco-regional relapse–free survival -- OS overall survival -- PSI paranasal sinus involvement -- PFS progression-free survival -- AJCC American Joint Committee on Cancer -- MRI magnetic resonance imaging -- UICC Union for International Cancer Control; AJCC staging system -- Nasopharyngeal carcinoma -- Paranasal sinus involvement -- Prognostic value -- Survival analysis -- T category; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2021.04.024
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: Paranasal sinus involvement (PSI) is an independent prognostic factor for NPC. The appropriate position in TNM staging system and diagnostic criteria of PSI has not reach on a uniform consensus yet. NPC patients with PSI should be classified into two groups: PSI-slight (sinus bone wall erosion only) and PSI-severe (tumor penetrate into sinus cavity). That survival outcomes of the patients with PSI-severe in T3 category are similar to those in AJCC T4 category disease. NPC patients with PSI-severe is recommended to classify as T4 category in AJCC staging system for NPC. Abstract: Purpose: This study aimed to evaluate the prognostic value of paranasal sinus involvement (PSI) in NPC and to explore its appropriate position in the current AJCC staging system. Materials and methods: Pretreatment MRI of 1317 patients with NPC treated with intensity-modulated radiotherapy (IMRT) between January 2010, and January 2013, were reviewed retrospectively. Survival was compared between patients with PSI-slight (sinus bone wall erosion only) and PSI-severe (tumor penetrated into sinus cavity). Multivariable analysis was performed to identify the independent predictors of survival. Results: The study included 1317 patients (median age 46 years; range, 11–78 years). PSI-slight was present in 15.2% (200/1317) patients and PSI-severe in 20.0% (263/1317) patients. Overall survival (OS), distant metastasis–free survival (DMFS), loco-regional recurrence–free survival (LRFS), and progression-free survival (PFS) were significantly lower in patients with PSI-severe (all P < .05). In multivariable analysis, PSI-severe was an independent prognostic factor for OS, DMFS, LRFS, and PFS (all P < .05). 96 AJCC T3 category patients with PSI-severe were reclassified as T4 category. The revised T category had significantly better predictive value (higher C-index) than that the AJCC system for survival (OS, .661 vs. .652; DMFS, .655 vs. .650; P < .05 for all). Conclusion: PSI-severe is an independent negative prognostic factor in nasopharyngeal carcinoma, which is recommended to be classified as T4 category in the 8th AJCC staging system for NPC.