Validation and development of a refined M1 category for nasopharyngeal carcinoma based on the version-nine of AJCC/UICC TNM staging system in the immunotherapy era: A multicenter cohort study

IF 7.9 1区医学 Q1 ONCOLOGY European Journal of Cancer Pub Date : 2025-03-26 Epub Date: 2025-02-12 DOI:10.1016/j.ejca.2025.115305

Hanchuan Xu , Yujun Hu , Tao Xie , Lihu Lu , Zhiwei Yan , Xinlan Chen , Lili Zhu , Chuanmiao Xie , Tianzhu Lu , Jingao Li , Jianji Pan , Shaojun Lin , Xiaochang Gong , Qiaojuan Guo

{"title":"Validation and development of a refined M1 category for nasopharyngeal carcinoma based on the version-nine of AJCC/UICC TNM staging system in the immunotherapy era: A multicenter cohort study","authors":"Hanchuan Xu , Yujun Hu , Tao Xie , Lihu Lu , Zhiwei Yan , Xinlan Chen , Lili Zhu , Chuanmiao Xie , Tianzhu Lu , Jingao Li , Jianji Pan , Shaojun Lin , Xiaochang Gong , Qiaojuan Guo","doi":"10.1016/j.ejca.2025.115305","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the applicability of the M1 category of the version-nine of AJCC/UICC TNM staging system (TNM-9) for M1 nasopharyngeal carcinoma (M1-NPC) in immunotherapy era and propose potential refinements.</div></div><div><h3>Methods</h3><div>M1-NPC patients who underwent palliative chemotherapy and immune checkpoint inhibitors (ICIs) between January 2019 and June 2023 across five institutions were included and re-staged according to TNM-9. Overall survival (OS) and Progression-free survival (PFS) were analyzed. A recursive partitioning analysis (RPA) model was employed to derive a new RPA-M1 category.</div></div><div><h3>Results</h3><div>Among the 472 patients included, 219 were M1a and 253 were M1b. With a median follow-up time of 27 months, the M1a subgroup exhibited significantly higher 2-year OS (90.4 % vs. 73.7 %) and PFS (69.2 % vs. 40.6 %) than M1b subgroup (all <em>P</em><0.001), which was further confirmed by multivariate analysis (MVA). Additionally, number of involved organs was found to be another independent predictor. New RPA-M1 category were then developed: RPA-M1a (≤3 metastatic lesions and confined to one single organ), RPA-M1b (≤3 metastatic lesions but involving multiple organs or >3 lesions and confined to one single organ), and RPA-M1c (patients with >3 metastatic lesions and involving multiple organs), with 2-year OS rates of 91.5 %, 81.4 %, and 69.8 %, respectively (<em>P</em> < 0.05) and PFS rates of 72.4 %, 54.3 % and 29.1 %, respectively (<em>P</em> < 0.005). Compared to the M1 Category in TNM-9, RPA-M1 category had a lower Akaike Information Criterion (AIC) and a higher concordance index (C-index) for OS and PFS.</div></div><div><h3>Conclusion</h3><div>The M1 category in the TNM-9 is applicable in the immunotherapy era. The RPA-M1 category offers improve depiction of survival outcomes compared to TNM-9, allowing for more refined stratification of patient outcomes and individulized decision-tailoring.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"219 ","pages":"Article 115305"},"PeriodicalIF":7.9000,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Cancer","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0959804925000863","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/12 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

To evaluate the applicability of the M1 category of the version-nine of AJCC/UICC TNM staging system (TNM-9) for M1 nasopharyngeal carcinoma (M1-NPC) in immunotherapy era and propose potential refinements.

Methods

M1-NPC patients who underwent palliative chemotherapy and immune checkpoint inhibitors (ICIs) between January 2019 and June 2023 across five institutions were included and re-staged according to TNM-9. Overall survival (OS) and Progression-free survival (PFS) were analyzed. A recursive partitioning analysis (RPA) model was employed to derive a new RPA-M1 category.

Results

Among the 472 patients included, 219 were M1a and 253 were M1b. With a median follow-up time of 27 months, the M1a subgroup exhibited significantly higher 2-year OS (90.4 % vs. 73.7 %) and PFS (69.2 % vs. 40.6 %) than M1b subgroup (all P<0.001), which was further confirmed by multivariate analysis (MVA). Additionally, number of involved organs was found to be another independent predictor. New RPA-M1 category were then developed: RPA-M1a (≤3 metastatic lesions and confined to one single organ), RPA-M1b (≤3 metastatic lesions but involving multiple organs or >3 lesions and confined to one single organ), and RPA-M1c (patients with >3 metastatic lesions and involving multiple organs), with 2-year OS rates of 91.5 %, 81.4 %, and 69.8 %, respectively (P < 0.05) and PFS rates of 72.4 %, 54.3 % and 29.1 %, respectively (P < 0.005). Compared to the M1 Category in TNM-9, RPA-M1 category had a lower Akaike Information Criterion (AIC) and a higher concordance index (C-index) for OS and PFS.

Conclusion

The M1 category in the TNM-9 is applicable in the immunotherapy era. The RPA-M1 category offers improve depiction of survival outcomes compared to TNM-9, allowing for more refined stratification of patient outcomes and individulized decision-tailoring.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

基于免疫治疗时代AJCC/UICC TNM分期系统version- 9的鼻咽癌M1分类的验证和发展：一项多中心队列研究

目的评价AJCC/UICC TNM分期系统第9版（TNM-9） M1分类在免疫治疗时代对M1鼻咽癌（M1- npc）的适用性，并提出可能的改进方案。方法纳入2019年1月至2023年6月期间在5家机构接受姑息性化疗和免疫检查点抑制剂（ICIs）治疗的sm1 - npc患者，并根据TNM-9重新分期。分析总生存期（OS）和无进展生存期（PFS）。采用递归划分分析（RPA）模型，推导出一个新的RPA- m1类别。结果纳入的472例患者中M1a 219例，M1b 253例。中位随访时间为27个月，M1a亚组的2年OS（90.4 % vs. 73.7 %）和PFS（69.2 % vs. 40.6 %）明显高于M1b亚组（p < 0.001），多变量分析（MVA）进一步证实了这一点。此外，受累器官的数量被发现是另一个独立的预测因子。新RPA-M1类别然后发达:RPA-M1a(≤3转移病变局限于一个单一的器官),RPA-M1b(≤3转移病灶,但涉及多个器官或在3病变局限于一个单一的器官),和RPA-M1c(患者在3转移病灶和涉及多个器官),2年操作系统利率91.5 %, % 81.4和69.8 %,分别(P & lt; 0.05)和PFS利率72.4 %,分别54.3 %和29.1 % (P & lt; 0.005)。与TNM-9中的M1分类相比，RPA-M1分类的OS和PFS的赤池信息标准（Akaike Information Criterion， AIC）较低，一致性指数（C-index）较高。结论TNM-9中的M1分类适用于免疫治疗时代。与TNM-9相比，RPA-M1分类提供了更好的生存结果描述，允许更精细的患者结果分层和个性化决策定制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

European Journal of Cancer 医学-肿瘤学

CiteScore

11.50

自引率

4.80%

发文量

953

审稿时长

23 days

期刊介绍： The European Journal of Cancer (EJC) serves as a comprehensive platform integrating preclinical, digital, translational, and clinical research across the spectrum of cancer. From epidemiology, carcinogenesis, and biology to groundbreaking innovations in cancer treatment and patient care, the journal covers a wide array of topics. We publish original research, reviews, previews, editorial comments, and correspondence, fostering dialogue and advancement in the fight against cancer. Join us in our mission to drive progress and improve outcomes in cancer research and patient care.