Japanese Journal of Clinical Oncology 31:363-369 (2001)
© 2001 Foundation for Promotion of Cancer Research
Retrospective Comparison of the AJCC 5th Edition Classification for Nasopharyngeal Carcinoma with the AJCC 4th Edition: an Experience in Taiwan
1Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, 2Department of Oncology, National Taiwan University Hospital, Taipei and 3Department of Radiation Therapy and Oncology, China Medical College Hospital, Taichung, Taiwan
Objective: The aim of this study was to compare the new AJCC 5th edition classification system for nasopharyngeal carcinoma (NPC) with the AJCC 4th edition by re-evaluating the staging of patients treated in Taiwan.
Methods: From 1992 through 1996, 117 NPC patients without distant metastasis were treated using complete courses of radiotherapy. All patients had complete CT examinations of the nasopharynx and neck. Each patient was re-staged according to the 5th edition of the AJCC classification system. Their overall survival (OS), loco-regional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS) and disease-free survival (DFS) were compared between the two staging systems, using the Kaplan–Meier method, log-rank test, Wilcoxon test and Cox proportional hazard model.
Results: After a median follow-up of 58.3 months, the 5-year OS for stage I, II, III and IV was 88, 86, 61 and 48%, respectively, according to the new staging. A more even distribution of patients was noted among the patients classified according to the AJCC 5th edition than the 4th edition. The distribution of stages I, II, III and IV was 13.7, 37.6, 15.4 and 33.3%, respectively, using the new staging system, whereas it was 0.8, 14.5, 20.5 and 64.2%, respectively, using the old staging system. More statistically significant differences among 5th edition stages and T classifications than the 4th edition were also noted.
Conclusions: The 5th edition of the AJCC staging system appears to have a more even distribution of patients and more statistically significant differences in predicting prognosis than the 4th edition, mostly in stages and T classification.
+ For reprints and all correspondence: Fang-Jen Lin, Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road, Shi-Lin, Taipei, Taiwan. E-mail: a0080@ms2.hinet.net
Abbreviations: AJCC, American Joint Committee on Cancer; CT, computed tomography; DFS, disease-free survival; DMFS, distant metastasis-free survival; DSS, disease-specific survival; ICHDR, intra-cavity high dose rate; LRRFS, loco-regional relapse-free survival; NPC, nasopharyngeal carcinoma; OS, overall survival
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