Staging of nasopharyngeal carcinoma: evaluation of N-staging by Ho and UICC/AJCC systems. Union Internationale Contre le Cancer. American Joint Committee for Cancer

Clin Oncol (R Coll Radiol). 1996;8(3):146-54. doi: 10.1016/s0936-6555(96)80038-0.


To evaluate the prognostic accuracy of N-staging by Ho's and the UICC/AJCC systems, 5020 patients with undifferentiated or poorly differentiated squamous cell carcinoma of the nasopharynx treated at the Queen Elizabeth Hospital, Hong Kong in the period 1976-1985 were analysed retrospectively. They were initially staged with Ho's system, but detailed records of nodal involvement allowed accurate retrospective restaging with the UICC/ AJCC (1988) system. Staging assessment depended almost entirely on physical examination; only 14% of patients had additional investigations with computed tomography. To evaluate the independent significance of different nodal parameters, T-stage adjusted analyses of the 4730 patients presenting without distant metastases were performed. Both N-staging systems showed a strongly significant overall correlation with distant failures and cancer-specific deaths. A significant trend was also shown for nodal failures in node-positive patients. Ho's system was superior in predicting distant failures, while the UICC/AJCC system was superior for nodal failures. However, even with due adjustment for level, the independent significance of nodal size, laterality and fixity could be demonstrated. After adjustment for UICC/AJCC N-stage, both level and fixity were also significant. Furthermore, when adjusted for all other meaningful parameters, there were no significant differences between ipsilateral and contralateral involvement, upper and mid-level extent, and nodal size < or = 3 cm or > 3- < or = 6 cm. N-staging can be further optimized by a newly proposed system incorporating fixity (movable versus fixed), level (upper-mid versus lower), size (greatest diameter < or = 6 cm versus > 6 cm), and laterality (unilateral versus bilateral) as staging criteria.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / pathology*
  • Carcinoma, Squamous Cell / radiotherapy
  • Carcinoma, Squamous Cell / secondary
  • Child
  • Evaluation Studies as Topic
  • Female
  • Follow-Up Studies
  • Hong Kong
  • Humans
  • Lymphatic Metastasis / pathology
  • Lymphatic Metastasis / radiotherapy
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Nasopharyngeal Neoplasms / pathology*
  • Nasopharyngeal Neoplasms / radiotherapy
  • Neoplasm Staging / methods*
  • Physical Examination
  • Prognosis
  • Proportional Hazards Models
  • Radiotherapy Dosage
  • Regression Analysis
  • Retrospective Studies
  • Survival Rate
  • Tomography, X-Ray Computed
  • Treatment Failure
  • Treatment Outcome