1.A new prognostic histopathologic classiifcation ofnasopharyngeal carcinoma
Hai-YunWang ; Yih-LeongChang ; Ka-FaiTo ; JacquelineS.G.Hwang ; Hai-QiangMai ; Yan-FenFeng ; EllenT.Chang ; Chen-PingWang ; MichaelKoonMingKam ; Shie-LeeCheah ; MingLee ; LiGao ; Hui-ZhongZhang ; Jie-HuaHe ; HaoJiang ; Pei-QingMa ; Xiao-DongZhu ; LiangZeng ; Chun-YanChen ; GangChen ; Ma-YanHuang ; ShaFu ; QiongShao ; An-JiaHan ; Hai-GangLi ; Chun-KuiShao ; Pei-YuHuang ; Chao-NanQian ; Tai-XiangLu ; Jin-TianLi ; WeiminYe ; IngemarErnberg ; HoKeungNg ; JosephT.S.Wee ; Yi-XinZeng ; Hans-OlovAdami ; AnthonyT.C.Chan1 ; Jian-YongShao
Chinese Journal of Cancer 2016;35(6):294-309
Background:The current World Health Organization (WHO) classiifcation of nasopharyngeal carcinoma (NPC) con?veys little prognostic information. This study aimed to propose an NPC histopathologic classiifcation that can poten?tially be used to predict prognosis and treatment response. Methods:We initially developed a histopathologic classiifcation based on the morphologic traits and cell differentia?tion of tumors of 2716 NPC patients who were identiifed at Sun Yat?sen University Cancer Center (SYSUCC) (training cohort). Then, the proposed classiifcation was applied to 1702 patients (retrospective validation cohort) from hospitals outside SYSUCC and 1613 patients (prospective validation cohort) from SYSUCC. The effcacy of radiochemotherapy and radiotherapy modalities was compared between the proposed subtypes. We used Cox proportional hazards models to estimate hazard ratios (HRs) with 95% conifdence intervals (CI) for overall survival (OS). Results:The 5?year OS rates for all NPC patients who were diagnosed with epithelial carcinoma (EC; 3708 patients), mixed sarcomatoid?epithelial carcinoma (MSEC; 1247 patients), sarcomatoid carcinoma (SC; 823 patients), and squamous cell carcinoma (SCC; 253 patients) were 79.4%, 70.5%, 59.6%, and 42.6%, respectively (P<0.001). In mul?tivariate models, patients with MSEC had a shorter OS than patients with EC (HR=1.44, 95% CI=1.27–1.62), SC (HR=2.00, 95% CI=1.76–2.28), or SCC (HR=4.23, 95% CI=3.34–5.38). Radiochemotherapy signiifcantly improved survival compared with radiotherapy alone for patients with EC (HR=0.67, 95% CI=0.56–0.80), MSEC (HR=0.58, 95% CI=0.49–0.75), and possibly for those with SCC (HR=0.63; 95% CI=0.40–0.98), but not for patients with SC (HR=0.97, 95% CI=0.74–1.28). Conclusions:The proposed classiifcation offers more information for the prediction of NPC prognosis compared with the WHO classiifcation and might be a valuable tool to guide treatment decisions for subtypes that are associ?ated with a poor prognosis.
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