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Войти в исследования BMC medicine · 2026
Defining optimal treatment strategies for nasopharyngeal carcinoma based on the ninth edition TNM staging system: insights from a multicenter cohort study in an endemic region.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Wang Gaoyuan, Huo Lanqing, Zhu Xiaodong, Lei Feng, Shen Liangfang, Yang Kunyu, Han Yaqian, Qin Guanjie, Wen Minyu, Li Jibin, Ma Jun, Du Xiaojing
Аннотация
BACKGROUND: The ninth edition AJCC/UICC staging system (TNM-9) for nasopharyngeal carcinoma (NPC) was released in 2025, prompting a need to redefine evidence-based treatment regimens. This study aimed to identify optimal therapies under the new criteria.
METHODS: In this multicenter cohort, we enrolled patients from endemic Chinese regions (2016‑2017) with non‑metastatic (M0) or de novo metastatic (M1) NPC. Propensity score matching (1:1 or 1:M) and inverse probability of treatment weighting minimized selection bias. Survival was compared via Kaplan‑Meier and Cox models.
RESULTS: The cohort comprised 6049 non-metastatic patients restaged by TNM-9 criteria, categorized into the following risk groups: low-risk (stage IA), intermediate-risk (stage IB and T3N0), high-intermediate-risk (T3N1), and high-risk (T1-3N2 and stage III). Additionally, 127 de novo metastatic patients were enrolled. Survival between concurrent chemoradiotherapy (CCRT) and intensity-modulated radiotherapy (IMRT) alone in the stage IA group was not significantly different (hazard ratio [HR]: 0.50; 95% CI: 0.05-5.50; P = 0.562). However, within the intermediate-risk group, CCRT demonstrated significantly improved 5-year OS (97.9% vs. 91.0%; P = 0.001). Among high-risk patients, induction chemotherapy (IC) followed by CCRT with or without adjuvant chemotherapy resulted in superior 5-year OS (83.9% vs. 78.6%; P = 0.003). Although reclassification under TNM-9 affected only a limited number of patients (n = 301), this subgroup exhibited a substantial survival benefit from the addition of IC (5-year OS: 83.2% vs. 66.4%; P = 0.001). A comprehensive treatment strategy combining systemic therapy, locoregional radiotherapy (LRRT), and maintenance therapy (MT) was associated with significantly prolonged survival (HR: 0.36; 95% CI: 0.23-0.55; and HR: 0.45, 95% CI: 0.25-0.79). Furthermore, local consolidation therapy of metastases (LCT) in M1a was associated with a non-significant trend longer median OS (89.0 vs. 62.4 months; P = 0.122).
CONCLUSIONS: Under the TNM-9, management recommendations were as follows: radical IMRT alone for stage IA; CCRT for stage IB and T3N0; and high-intensity therapy for high-risk disease, including reclassified subsets. For metastatic disease, the addition of LRRT and MT to systemic therapy was associated with improved survival in both M1a and M1b patients, whereas a trend toward potential benefit from LCT was observed only in M1a subgroup.
METHODS: In this multicenter cohort, we enrolled patients from endemic Chinese regions (2016‑2017) with non‑metastatic (M0) or de novo metastatic (M1) NPC. Propensity score matching (1:1 or 1:M) and inverse probability of treatment weighting minimized selection bias. Survival was compared via Kaplan‑Meier and Cox models.
RESULTS: The cohort comprised 6049 non-metastatic patients restaged by TNM-9 criteria, categorized into the following risk groups: low-risk (stage IA), intermediate-risk (stage IB and T3N0), high-intermediate-risk (T3N1), and high-risk (T1-3N2 and stage III). Additionally, 127 de novo metastatic patients were enrolled. Survival between concurrent chemoradiotherapy (CCRT) and intensity-modulated radiotherapy (IMRT) alone in the stage IA group was not significantly different (hazard ratio [HR]: 0.50; 95% CI: 0.05-5.50; P = 0.562). However, within the intermediate-risk group, CCRT demonstrated significantly improved 5-year OS (97.9% vs. 91.0%; P = 0.001). Among high-risk patients, induction chemotherapy (IC) followed by CCRT with or without adjuvant chemotherapy resulted in superior 5-year OS (83.9% vs. 78.6%; P = 0.003). Although reclassification under TNM-9 affected only a limited number of patients (n = 301), this subgroup exhibited a substantial survival benefit from the addition of IC (5-year OS: 83.2% vs. 66.4%; P = 0.001). A comprehensive treatment strategy combining systemic therapy, locoregional radiotherapy (LRRT), and maintenance therapy (MT) was associated with significantly prolonged survival (HR: 0.36; 95% CI: 0.23-0.55; and HR: 0.45, 95% CI: 0.25-0.79). Furthermore, local consolidation therapy of metastases (LCT) in M1a was associated with a non-significant trend longer median OS (89.0 vs. 62.4 months; P = 0.122).
CONCLUSIONS: Under the TNM-9, management recommendations were as follows: radical IMRT alone for stage IA; CCRT for stage IB and T3N0; and high-intensity therapy for high-risk disease, including reclassified subsets. For metastatic disease, the addition of LRRT and MT to systemic therapy was associated with improved survival in both M1a and M1b patients, whereas a trend toward potential benefit from LCT was observed only in M1a subgroup.