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BioMed Research International
Volume 2017, Article ID 1419676, 11 pages
Research Article

A Study of 358 Cases of Locally Advanced Nasopharyngeal Carcinoma Receiving Intensity-Modulated Radiation Therapy: Improving the Seventh Edition of the American Joint Committee on Cancer T-Staging System

Department of Oncology, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, Hunan Province 410008, China

Correspondence should be addressed to Liangfang Shen; moc.361@gnafgnailnehs

Received 20 September 2016; Revised 30 November 2016; Accepted 28 December 2016; Published 7 February 2017

Academic Editor: Charnita M. Zeigler-Johnson

Copyright © 2017 Qin Zhou et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


To evaluate the rationality and limitations of the seventh edition of the American Joint Committee on Cancer (the 7th AJCC edition) T-staging system for locally advanced nasopharyngeal carcinoma (NPC). The prognosis of 358 patients with stage T3/T4 NPC treated with intensity-modulated radiotherapy (IMRT) was analyzed with the Kaplan–Meier method or the log-rank test. The 7th AJCC staging system of NPC has some limitations in that the T category is neither the significant factor in OS/LRFS nor the independent prognostic factor in OS/LRFS/DMFS/DFS (). After adjustment by anatomic structures, univariate analysis has shown that the adjusted-T category has statistical significance between T3 and T4 for OS (86.4% and 71.3%, ), LRFS (97% and 90.9%, ), DMFS (90.9% and 77.2%, ), and DFS (86.2% and 67.5%, ), and multivariate analysis has shown that the adjusted-T category is an independent prognostic factor for OS/DMFS/DFS (with the exception of LRFS). Then, GTV-P was taken into consideration. Multivariate analysis showed that these nT categories serve as suitable independent prognostic factors for OS/DMFS/DFS () and LRFS (HR = 3.131; 95% CI, 1.090–8.990; ). The 7th AJCC staging system has limitations and should be improved by including the modifications suggested, such as anatomic structures and tumor volume adjustment.