CNG Staging Compared With 8th UICC of NPC for Treatment Decision-marking and Selection of Chemotherapy and Radiotherapy

Due to the increase of tumor control rate and survival rate in era of IMRT, the role of the seventh edition of UICC/AJCC staging system in predicting prognosis is becoming weaker and inaccurate. Therefore, we put forward a new staging for the clinical staging of NPC in the era of IMRT without changing the current T, N, M staging definition of the 7th of the UICC/AJCC staging system. We call this new stage "Cooperative Nasopharyngeal Carcinoma Group" stage, namely CNG stage. In CNG stage, the clinical stages were reduced to three stages, namely, CNG I stage includes T1-3N0-1M0 and T1-2N2M0, CNG II stage includes T3N2M0, T4N0-2M0 and TanyN3M0, CNG III stage includes TanyNanyM1. For CNG I stage, the IMRT alone is sufficient. If EBV-DNA copies is more than 0 copy/ml, concurrent chemoradiotherapy will be given. For CNG II stage, patients can benefit from combined radiotherapy and chemotherapy. For CNG III stage, patients are recommended for systemic chemotherapy plus local radiotherapy (primary focus, neck drainage area and distant metastasis). This year, UICC/AJCC has proposed an eighth edition of NPC staging system. The eighth version is mainly changed in the definition and refinement of the anatomic location compared with the seventh edition. This is different from our new CNG staging concept. Therefore, CNG staging and its treatment strategy was used as the experimental group, and the eighth edition of UICC/AJCC staging with NCCN guiding treatment was used as the control group. The open and randomized controlled clinical study was conducted. The purpose of this study was to evaluate in the era of IMRT, CNG staging can be better than UICC/AJCC eighth clinical staging for treatment decision-marking and selection of chemotherapy and radiotherapy, and differentiating differences in prognosis in each clinical stage. The survival results based on CNG staging and its treatment are not inferior to the survival results of the NCCN guide therapy based on the eighth edition UICC/AJCC staging, to avoid chemotherapy for some of the patients, and to improve the outcome of metastatic patients.

Sex

All

Minimum age

18 Years

Maximum age

65 Years

Inclusion Criteria:

* Pathologically confirmed and previously untreated nasopharyngeal carcinoma
* Non T1N0M0 patient according to UICC/AJCC seventh edition staging system
* Age ≥ 18 years and \< 65 years
* Karnofsky performance status (KPS) score ≥ 70
* Adequate normal organ function
* No history of other malignant tumors
* No serious mental disorder (schizophrenia, delusion of victimization, manic depression, and drug induced anxiety)
* No AIDS, active pulmonary tuberculosis and other serious immunodeficiency diseases
* No communication barrier, can answer the question
* Sign informed consent under voluntary circumstances, complete treatment and follow up as required

Exclusion Criteria:

* Poor compliance
* Investigators consider as inappropriate for enrolling into this study

• DERIVEDZheng S, Liu Y, He Z, He S, Huang Z, Luo W, Han F, Tao Y, Chen C, Ouyang P, Chen L, Huang Y, Zhou G, Li W, Liu Q, Chen C, Xia Y. CNG (Collaborative Nasopharyngeal Carcinoma Group) stage: Improved prognostic stratification of nasopharyngeal carcinoma and association with Epstein-Barr virus DNA in the intensity-modulated radiation therapy era. Radiother Oncol. 2025 Sep;210:111051. doi: 10.1016/j.radonc.2025.111051. Epub 2025 Jul 19. PMID 40692079