Staging of non-metastatic nasopharyngeal carcinoma with PET/CT
1
Issued Date
2026-01-01
Resource Type
ISSN
09387994
eISSN
14321084
Scopus ID
2-s2.0-105036322369
Pubmed ID
42009870
Journal Title
European Radiology
Rights Holder(s)
SCOPUS
Bibliographic Citation
European Radiology (2026)
Suggested Citation
Cao C., Treechairusame T., Wu Y., Shamseddine A., Yu Y., Riaz N., Gelblum D.Y., McBride S.M., Kang J.J., Zakeri K.J., Tsai C.J., Wong R.J., Cracchiolo J.R., Cohen M.A., Ganly I.A., Shah J.P., Ho A.L., Wong W.L., Dunn L.A., Michel L.S., Sherman E.J., Lee N.Y. Staging of non-metastatic nasopharyngeal carcinoma with PET/CT. European Radiology (2026). doi:10.1007/s00330-026-12537-0 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/116390
Title
Staging of non-metastatic nasopharyngeal carcinoma with PET/CT
Corresponding Author(s)
Other Contributor(s)
Abstract
Objectives: To evaluate the prognostic accuracy and clinical applicability of the ninth edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) tumor-node-metastasis (TNM) staging system for non-metastatic nasopharyngeal carcinoma (NPC) in the era of [<sup>18</sup>F]-fluorodeoxyglucose ([<sup>18</sup>F] FDG) positron emission tomography (PET)/computed tomography (CT). Materials and methods: This retrospective study included 301 patients with NPC treated by intensity-modulated radiotherapy at a tertiary academic cancer center from January 1, 2003, to February 28, 2023. The comparison between the ninth edition of the AJCC/UICC TNM (TNM-9) and the eighth edition of the AJCC/UICC TNM (TNM-8) staging systems was performed. The primary endpoint was overall survival (OS). Results: The proportions of patients receiving [<sup>18</sup>F] FDG PET/CT and magnetic resonance imaging as initial workup were 99.3% (299/301) and 96.9% (289/301), respectively. The median follow-up time was 88.1 months (interquartile range (IQR), 51.1–136.8 months). Based on the TNM-9 staging system, the 5-year OS rates of patients with Stage I, II and III were 91.7%, 84.8% and 76.8%, respectively (p = 0.090). The 5-year OS rates of patients with classification N0, N1, N2, and N3 were 92.0%, 87.1%, 77.6% and 79.1%, respectively (p = 0.879). The area under the receiver-operator characteristic curve values of the TNM-9 and TNM-8 were 0.6239 and 0.6678 for OS (p = 0.0003), respectively. Conclusion: The TNM-9 staging system did not exhibit strong overall discrimination between the stage-group classifications for OS of non-metastatic NPC in the [<sup>18</sup>F]FDG PET era. Key Points: Question Does the newly launched TNM-9 staging system (January 2025) remain valid for non-metastatic NPC in the era of [<sup>18</sup>F] FDG PET/CT? Findings The TNM-9 staging system showed declining 5-year overall survival rates from Stage I to III, with modest overall predictive accuracy for overall survival. Clinical relevance These findings suggest that the TNM-9 staging system has a limited ability to discriminate overall survival between stage groups in non-metastatic NPC in the [<sup>18</sup>F] FDG PET/CT era.