Proposal for the 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy
Jian Ji Pan, Wai Tong Ng, Jing Feng Zong, Lucy L. K. Chan, Brian O'Sullivan, Shao Jun Lin, Henry C. K. Sze, Yun Bin Chen, Horace C. W. Choi, Qiao Juan Guo, Wai Kuen Kan, You Ping Xiao, Xu Wei, Quynh Thu Le, Christine M. Glastonbury, A. Dimitrios Colevas, Randal S. Weber, Jatin P. Shah and Anne W. M. Lee
Article first published online: 20 NOV 2015 | DOI: 10.1002/cncr.29795
On the basis of a literature review and analyses of 1609 patients with nasopharyngeal cancer staged and treated with contemporary methods, the following changes will be recommended for the 8th edition of the American Joint Committee on Cancer/International Union Against Cancer staging system: changing pterygoid muscle involvement from T4 to T2, adding prevertebral muscle involvement as T2, replacing the supraclavicular fossa with the lower neck (extension below the caudal border of the cricoid cartilage) and merging this with a maximum nodal diameter > 6 cm as N3, and merging T4 and N3 as stage IVA criteria. These changes will lead not only to a better distinction of hazards between adjacent stages/categories but also to an optimal balance in clinical practicability and global applicability.