Challenges in the modification of the M1 stage of the TNM staging system for nasopharyngeal carcinoma: A study of 1027 cases and review of the literature

Pan,Chang-Chuan; Lu,Jin; Yu,Jing-Rui; Chen,Ping; Li,Wang; Huang,Zi-Lin; Zhao,Ming; Huang,Zhi-Mei; Xia,Yun-Fei; Wu,Yan-Hen; Wu,Pei-Hong

doi:10.3892/etm.2012.584

August 2012 Volume 4 Issue 2

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August 2012 Volume 4 Issue 2

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Article

Challenges in the modification of the M1 stage of the TNM staging system for nasopharyngeal carcinoma: A study of 1027 cases and review of the literature

Authors:
- Chang-Chuan Pan
- Jin Lu
- Jing-Rui Yu
- Ping Chen
- Wang Li
- Zi-Lin Huang
- Ming Zhao
- Zhi-Mei Huang
- Yun-Fei Xia
- Yan-Hen Wu
- Pei-Hong Wu
View Affiliations / Copyright

Affiliations: Medical Oncology, Sichuan Cancer Hospital and Institute, The Second People's Hospital of Sichuan Province, Sichuan, P.R. China , Department of Medical Imaging and Interventional Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China
Pages: 334-338
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Published online on: May 21, 2012

https://doi.org/10.3892/etm.2012.584
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Abstract

A series of modifications have been introduced to the TNM staging system over time for nasopharyngeal carcinoma (NPC), mainly focused on the T (primary tumor) and N (local node) components of the system. The M1 stage is a ‘catch all’ classification, covering a group of patients whose outlook ranges from potentially curable to incurable. Since the current M1 stage does not allow clinicians to stratify patients according to prognosis or guide therapeutic decision‑making and allow comparison of results of radical and non-radical treatments, we aimed to subdivide the M1 stage according to a retrospective study of 1027 metastatic NPC patients and to review the relevant literature. Between 1995 and 2007, 1027 inpatients with distant metastasis from NPC were retrospectively analyzed. Various possible subdivisions of the M1 stage were considered, looking at different metastatic sites, the number of metastatic organs and the number of metastases. Survival rates were calculated using the Kaplan‑Meier method and compared using the log-rank test. The most frequently involved metastatic sites were the bone, lung and liver. The incidence rates of solitary metastatic lesions and pulmonary metastasis were 16.2 and 41.3%. Despite the poor survival of these patients with a median survival of 30.8 months, patients in the metachronous metastatic group with metastases to the lung and/or solitary lesions, were defined as M1a, and were signiﬁcantly associated with favorable median survival of 41.5 and 49.1 months in the univariate and multivariate analysis, respectively. Patients in the metachronous metastatic group with metastasis to the lung and/or solitary lesions (M1a) have a more favorable prognosis compared with those patients with multiple metastases located in other anatomic sites (M1b). These data, in one of the largest reported metastatic NPC cohorts, are the ﬁrst to show the prognostic impact of metastatic status in NPC. As a powerful predictor, the potential clinical value of a modified M1 of the TNM system for NPC will facilitate patient counseling and individualize management.

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Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Challenges in the modification of the M1 stage of the TNM staging system for nasopharyngeal carcinoma: A study of 1027 cases and review of the literature

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