Prognostic Factors for Overall Survival in Nasopharyngeal Cancer and Implication for TNM Staging by UICC: A Systematic Review of the Literature

This study aims to identify prognostic factors in nasopharyngeal carcinoma (NPC) to improve the current 8th edition TNM classification. A systematic review of the literature reported between 2013 and 2019 in PubMed, Embase, and Scopus was conducted. Studies were included if (1) original clinical stu...

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Bibliographic Details
Published in:	Frontiers in oncology Vol. 11; p. 703995
Main Authors:	Chiang, Chi Leung, Guo, Qiaojuan, Ng, Wai Tong, Lin, Shaojun, Ma, Tiffany Sze Wai, Xu, Zhiyuan, Xiao, Youping, Li, Jishi, Lu, Tianzhu, Choi, Horace Cheuk Wai, Chen, Wenqi, Chau, Eric Sze Chun, Luk, Peter Ho Yin, Huang, Shao Hui, O’Sullivan, Brian, Pan, Jianji, Lee, Anne Wing Mui
Format:	Journal Article
Language:	English
Published:	Frontiers Media S.A 02-09-2021
Subjects:	AJCC/UICC staging system anatomical criteria nasopharyngeal carcinoma Oncology prognostic factors systematic review TMN classification
Online Access:	Get full text
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Summary:	This study aims to identify prognostic factors in nasopharyngeal carcinoma (NPC) to improve the current 8th edition TNM classification. A systematic review of the literature reported between 2013 and 2019 in PubMed, Embase, and Scopus was conducted. Studies were included if (1) original clinical studies, (2) ≥50 NPC patients, and (3) analyses on the association between prognostic factors and overall survival. The data elements of eligible studies were abstracted and analyzed. A level of evidence was synthesized for each suggested change to the TNM staging and prognostic factors. Of 5,595 studies screened, 108 studies (44 studies on anatomical criteria and 64 on non-anatomical factors) were selected. Proposed changes/factors with strong evidence included the upstaging paranasal sinus to T4, defining parotid lymph node as N3, upstaging N-category based on presence of lymph node necrosis, as well as the incorporation of non-TNM factors including EBV-DNA level, primary gross tumor volume (GTV), nodal GTV, neutrophil-lymphocyte ratio, lactate dehydrogenase, C-reactive protein/albumin ratio, platelet count, SUVmax of the primary tumor, and total lesion glycolysis. This systematic review provides a useful summary of suggestions and prognostic factors that potentially improve the current staging system. Further validation studies are warranted to confirm their significance.
Bibliography:	content type line 23 SourceType-Scholarly Journals-1 Edited by: Yong Yin, Shandong Cancer Hospital, China This article was submitted to Head and Neck Cancer, a section of the journal Frontiers in Oncology Reviewed by: Maria Grazia Ghi, Veneto Institute of Oncology (IRCCS), Italy; Qiqi Xie, Affiliated Hospital of Qinghai University, China
ISSN:	2234-943X 2234-943X
DOI:	10.3389/fonc.2021.703995