鼻咽癌2008年与1992年及2002年国际抗癌联盟分期法的病例对比研究

目的 研究鼻咽癌2008年分期、1992年分期及2002年国际抗癌联盟(UICC)分期3种方法的区别,并探讨2008年分期方法改变的依据.方法 对285例病理确诊的鼻咽癌进行回顾性分析,以3种不同的分期方法分别进行分期,对比分期结果,率及构成比的比较采用χ2检验.结果 纳入统计的285例中,采用2008年分期时,T分期T1期66例、T2期84例、T3期72例、T4期63例,N分期N0期12例、N1期48例、N2期169例、N3期56例,临床分期Ⅰ期5例、Ⅱ期30例、Ⅲ期141例、Ⅳ期109例;采用2002年UICC分期法时,T分期T1期66例、T2期83例、T3期55例、T4期81例,N分期N0期26例、N1期50例、N2期201例、N3期8例,临床分期Ⅰ期6例、Ⅱ期40例、Ⅲ期153例、Ⅳ期86例;采用1992年分期法时,T分期T1期62例、T2期91例、T3期71例、T4期61例,N分期N0期26例、N1期189例、N2期61例、N3期9例,临床分期Ⅰ期6例、Ⅱ期110例、Ⅲ期98例、Ⅳ期71例.2008年与1992年分期结果比较,T分期3例上升,9例下降;N分期216例上升,1例下降;临床分期121例上升,2例下降.2008年分期与2002年UICC分期结果比较,T分期8例上升,27例下降;N分期77例上升;临床分期54例上升,20例下降.对各期构成比的差异进行χ2检验,结果显示,T分期3种分期法间总体构成比差异无统计学意义(χ2=6.916,P=0.329),N分期3种分期法间总体构成比差异有统计学意义(χ2=275.169,P＜0.0125),临床分期3种分期法间构成比差异有统计学意义(χ2=84.515,P＜0.0125).结论 鼻咽癌2008年分期以MRI为依据,操作更简便,明确了一些模糊的解剖结构,与以往分期法结果比较,主要对N分期影响较大且以升级为主,从而影响到最终的临床分期,并使分期构成比发生一定改变.

Comparison analysis of Chinese 2008, 1992 and 2002 UICC staging system for nasopharyngeal carcinoma

Objective To compare the Chinese 2008, 1992 and 2002 UICC (International Union Against Cancer) staging System for nasopharyngeal carcinoma and find out the reasons for the changes in the new Chinese 2008 staging system. Methods From Apr. 2007 to Dec. 2008, 285 naive patients with pathologically proved NPC, but without metastasis, received standard enhanced MRI scans of the nasopharynx and neck. Based on MRI imaging data and clinical information, clinical stage was classified according to the Chinese 2008, Chinese 1992 staging system and 2002 6th UICC staging system,respectively. Comparisons were made between Chinese 2008 and 1992 staging system, and between Chinese 2008 and 2002 UICC staging system by χ2 test. Results As a result of deleting some details of the old staging system, Chinese 2008 staging system is easier to grasp. With Chinese 2008 staging system, the number of cases in stage T1 to T4 are 66, 84, 72,63, respectively; those in stage N0 to N3 are 12,48,169,56; the number of cases in clinical stage Ⅰ -Ⅳ are 5,30,141 and 109. With 2002 6th UICC staging system, the number of cases in stage T1 to T4 are 66, 83, 55,81; those in stage N0 to N3 are 26,50,201,8;the number of cases in clinical stage Ⅰ -Ⅳ are 6,40,153 and 86. With Chinese 1992 staging system, the number of cases in stage T1 to T4 are 62,91,71,61; those in stage No to N3 are 26,189,61,9; the number of cases in clinical stage Ⅰ -Ⅳ are 6, 110, 98 and 71. Comparing with the staging results of Chinese 1992 staging system, many cases showed different stage based on Chinese 2008 system including 12 cases (4.21%) inT stage (3 up-staging and 9 down-staging), 217 cases (76.14%) in N stage (216 up-staging, most rise I stage, and 1 down-staging), 123 cases (43. 16% ) in clinical stage ( 121 up-staging and 2 down-staging). Comparing with the staging results of 2002 UICC staging system, 35 cases ( 12. 28% )changes in T stage (8 up-staging and 27 down-staging), 77 cases (27. 02% ) changes in N stage (all upstaging, most rise 1 stage), 74 cases (25. 95% ) changes in clinical stage (54 up-staging and 20 downstaging) based on Chinese 2008. Comparing the constituent ratio of T, N and clinical staging results separately, statistical differences were found between Chinese 2008 and Chinese 1992 staging system in N0,N1, N2, N3, clinical stage Ⅱ , Ⅲ, Ⅳ. Statistical difference was also found in N0, N2, N3, clinical stage Ⅳ between Chinese 2008 and 2002 UICC staging system. χ2 test results show that there is N0 significant difference of T stage constituent ratio among the 3 staging system ( χ2 = 6. 916, P = 0. 329 ), but the difference of N stage and clinical stage constituent ratio are significant( χ2 = 275. 169 and 84. 515, P ＜0. 0125). Conclusion Chinese 2008 Staging System for nasopharyngeal carcinoma is based on MRI, with clear definition to some anatomical location, after deleting some details in the old stage system, it's easier to use. The most obvious change for Chinese 2008 Staging System is the up-staging in N staging,which leads to the changes in clinical stage and constituent ratio of stage result.