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Familial nasopharyngeal carcinomas possess distinguished clinical characteristics in southern China

Chinese Journal of Cancer Research 2014年第5期26卷 543-549页

作者： Su-Mei Cao Sui-Hong Chen Chao-Nan Qian Qing Liu yun-fei xia State Key Laboratory of Oncology in South China and Department of Cancer Prevention Research Sun Yat-Sen University Cancer Center State Key Laboratory of Oncology in South China and Department of Nasopharyngeal Carcinoma Sun Yat-Sen University Cancer Center State Key Laboratory of Oncology in South China and Department of Radiation Oncology Sun Yat-Sen University Cancer Center

Objective： To compare clinical characteristics between familial nasopharyngeal carcinomas（NPCs） and sporadic NPCs in Guangdong province, China, a high-risk area.Methods： Between 1991 and 2001, 993 NPC patients treated at the Cancer Center of Sun Yat-Sen University in Guangdong were randomly selected as probands. Information about NPC among the probands＇ relatives and other information were obtained from a retrospective review of the patients＇ medical records. The patients were divided into sporadic NPC, low-frequency familial NPC（one NPC patient in addition to the proband in three generations）, and high-frequency familial NPC（2 or more additional NPC patients in three generations） groups. Pathological and clinical characteristics were compared among these groups.Results： Of the 993 patients, 131（13.2%） had a familial history of NPC. The average age at diagnosis was the lowest in the high-frequency familial NPC group（39 years; P=0.048）. Although the overall survival（OS）, distant metastasis-free survival（DMFS）, and disease-free survival（DFS） rates did not differ between familial and sporadic NPCs, the locoregional recurrence-free survival（LRFS） rate increased in the order sporadic NPCs, low-frequency familial NPCs, and high-frequency familial NPCs（P=0.009）, with 5-year rates of 70%, 83%, and 87%, respectively. Multivariate analysis showed that family history of NPC was an independent favorable prognostic factor for LRFS, with adjusted hazard ratio（a HR） of 0.548, 95% CI（0.342-0.878）. The high LRFS for familial NPCs was mainly noted among young, advanced-stage patients who received continuous radiation treatment.Conclusions： Genetic factors may play an important role in the etiology of high-frequency familial NPC and underlie the early age of onset and sensitivity to radiotherapy.

关键词： Nasopharyngeal carcinoma（NPC） familial clinical behavior

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Relationship between traditional Chinese medicine syndrome differentiation and imaging characterization to the radiosensitivity of nasopharyngeal carcinoma

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Chinese Journal of Cancer 2010年第11期29卷 937-945页

作者： Hong Bao Jing Gao Tao Huang Zi-Ming Zhou Bei Zhang yun-fei xia Department of Medical Imaging Yueyang Hospital of Integrated Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai 200437 P. R. China Department of Radiation Oncology Sun Yat-sen University Cancer Center Guangzhou Guangdong 510060 P. R. China Department of Internal Traditional Chinese Medicine Yueyang Hospital of Integrated Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai 200437 P. R. China Department of Traditional Chinese Medicine Sun Yat-sen University Cancer Center Guangzhou Guangdong 510060 P. R. China

Background and Objective: Traditional Chinese medicine (TCM) is a well established and time-honored practice in China, employing syndrome differentiation as a basis for the treatment of disease. According to different TCM syndrome typing findings, combining modern medical methods with TCM approaches can improve the quality of life and comprehensive effect on patients with nasopharyngeal carcinoma (NPC). This study investigated the relationship between TCM syndrome typing and imaging characterization to radiosensitivity as to provide objective evidence for the integration of Chinese and modern medical approaches in the treatment of NPC. Methods: Prior to treatment, TCM syndrome typing, computed tomography (CT) and magnetic resonance imaging (MRI) were performed on 147 patients pathologically classified with NPC. The status of tumor remission was radiologically evaluated at accumulated doses of 20 Gy, 40 Gy and 60 Gy, and at 3 months after completion of radiotherapy. Statistical results were analyzed by the Friedman and K-W test procedures. Results: Prior to treatment, TCM syndrome typing of NPC included Lung Heat, Blood Stasis, Phlegm Congealment and Blood Stasis-Phlegm Congealment. Lung Heat typing accounted for the highest proportion at 34.7% (51/147), followed by Phlegm Congealment at 32.7% (48/147), Blood Stasis at 17.0% (25/147) and Blood Stasis-Phlegm Congealment at 15.7% (23/147). Radiological imaging demonstrated a higher incidence of cervical lymph node metastases in Phlegm Congealment and Blood Stasis-Phlegm Congealment types (P < 0.05), while Blood Stasis and Blood Stasis-Phlegm Congealment types were more prone to skull base invasion (P < 0.05). Residual tumor size was larger in Blood Stasis and Blood Stasis-Phlegm Congealment types than in Lung Heat and Phlegm Congealment types after 3 months of treatment (P < 0.05). Conclusions: Different radiological manifestations were observed in TCM syndrome typed NPC patients, with lesser radiosensitivity demonstrated in the Blood Stasis and the Blood Stasis-Phl

关键词：放射敏感性中医证候鼻咽癌成像特性放射影像学放射治疗辨证血瘀证

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The clinical characteristics and treatment outcomeof 57 children and adolescents with primary central nervoussystem germ cell tumors

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Chinese Journal of Cancer 2014年第8期33卷 395-401页

作者： xiao-fei Sun fei Zhang Zi-Jun Zhen Qun-Ying Yang yun-fei xia Shao-Xiong Wu Jia Zhu Su-Ying Lu Juan Wang fei-fei Sun Rui-Qing Cai Yan Chen Peng-fei Li State Key Laboratory of Oncology in South China Collaborative Innovation Center of Cancer Medicine Department of Pediatric Oncology Sun Yat-sen University Cancer Center Department of Neurosurgery Sun Yat-sen University Cancer Center Department of Radiation Oncology Sun Yat-sen University Cancer Center

Primary central nervous system germ cell tumors(CNS-GCTs) in children and adolescents have unique clinical features and methods of treatment compared with those in adults. There is little information about Chinese children and adolescents with CNS-GCTs. Therefore, in this study we retrospectively analyzed the clinical features and treatment outcome of Chinese children and adolescents with primary CNS-GCTs. Between January 2002 and December 2012, 57 untreated patients from a single institution were enrolled. They were diagnosed with CNS-GCTs after pathologic or clinical assessment. Of the 57 patients, 41 were males and 16 were females, with a median age of 12.8 years(range, 2.7 to 18.0 years) at diagnosis; 43(75.4%) had non-germinomatous germ cell tumors(NGGCTs) and 14(24.6%) had germinomas; 44(77.2%) had localized disease and 13(22.8%) had extensive lesions. Fifty-three patients completed the prescribed treatment, of which 18 underwent monotherapy of surgery, radiotherapy, or chemotherapy, and 35 underwent multimodality therapies that included radiotherapy combined with chemotherapy or surgery combined with chemotherapy and/or radiotherapy. PEB(cisplatin, etoposide, and bleomycin) protocol was the major chemotherapy regimen. The median follow-up time was 32.3 months(range, 1.2 to 139 months). Fourteen patients died of relapse or disease progression. The 3-year event-free survival(EFS) and overall survival rates for all patients were 72.2% and 73.8%, respectively. The 3-year EFS was 92.9% for germinomas and 64.8% for NGGCTs(P = 0.064). The 3-year EFS rates for patients with NGGCTs who underwent monotherapy and multimodality therapies were 50.6% and 73.5%, respectively(P = 0.042). Our results indicate that multimodality therapies including chemotherapy plus radiotherapy were better treatment option for children and adolescents with CNS-GCTs.

关键词：中枢神经系统手术治疗生殖细胞临床特点青少年原发性儿童综合治疗

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Long-term molecular changes in WHO grade II astrocytomas following radiotherapy

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Chinese Journal of Cancer 2012年第3期31卷 159-165页

作者： Wei-Ying Yue Ke Sai Qiu-Liang Wu yun-fei xia Su-Huan Yu Zhong-Ping Chen State Key Laboratory of Oncology in South China Oepartment of Neurosurgery Department of Pathology Department of Radiation Oncology Sun Yat-sen University Cancer Center Guangzhou Guangdong 510060 P. R. China Department of Neurosurgrey Zhongnan Hospital Wuhan University Wuhan Hubei 430077. P. R. China.

Monitoring the long-term radiotherapy-associated molecular changes in low-grade gliomas(LGGs) facilitates the understanding of LGG response to radiotherapy.In this study,we used immunohistochemistry to analyze the expression of Ki-67,tumor protein P53(TP53),P21,and P27 in 8 paired WHO grade II astrocytoma samples.The interval between radiotherapy(RT) and the second surgery was more than 3 months in all cases.The average Ki-67 labeling index(LI) was 5.3% in pre-RT samples and 11.54% in post-RT samples.Ki-67 LI was higher in the primary tumors that underwent malignant transformation observed at the second surgery after radiation.Post-RT Ki-67 LI decreased in 2 cases with an interval of less than 12 months between RT and the second surgery.TP53 expression was found in 3 out of 4 pre-RT samples with malignant transformation and in 1 out of 4 pre-RT samples without malignant transformation.Post-RT TP53 increased in 2 cases in which increased expression of P21 or P27 was also observed.Our study suggests that radiotherapy can inhibit WHO grade II astrocytoma proliferation as reflected by Ki-67 LI,but the effect attenuates with time.In addition,there is a tendency of malignant transformation for WHO grade II astrocytomas with a high Ki-67 level or TP53 expression in initial samples.

关键词：星形细胞放疗世卫组织分子 P53基因二级时间间隔世界卫生组织

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Increased pretreatment levels of serum LDH and ALP as poor prognostic factors for nasopharyngeal carcinoma

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Chinese Journal of Cancer 2012年第4期31卷 197-206页

作者： Guo Li Jin Gao Ya-Lan Tao Bing-Qing Xu Zi-Wei Tu Zhi-Gang Liu Mu-Sheng Zeng yun-fei xia State Key Laboratory of Oncology in South China Guangzhou Guangdong 510060 P. R. China Department of Radiation Oncology Sun Yat-sen University Cancer Center Guangzhou Guangdong 510060 P. R. China

Serum enzymes that play potential roles in tumor growth have recently been reported to have prognostic relevance in a diverse array of tumors.However,prognosis-related serum enzymes are rarely reported for nasopharyngeal carcinoma(NPC).To clarify whether the level of serum enzymes is linked to the prognosis of NPC,we reviewed the pretreatment data of lactate dehydrogenase(LDH),alkaline phosphatase (ALP),and glutamyl transferase (GGT) in 533 newly diagnosed NPC patients who underwent radical radiotherapy between May 2002 and October 2003 at Sun Yat-sen University Cancer Center.Patients were grouped according to the upper limit of normal values of LDH,ALP,and GGT.The Kaplan-Meier method and log-rank test were used for selecting prognostic factors from clinical characteristics and serum enzymes,and the chi-square test was applied to analyze the relationships of clinical characteristics and serum enzymes.Finally,a Cox proportional hazards model was used to identify the independent prognostic factors.We found that increased levels of LDH had poor effects on both overall survival and distant metastasis-free survival(P=0.009 and 0.035,respectively),and increased pretreatment level of serum ALP had poor effects on both overall survival and local recurrence-free survival(P=0.037 and 0.039,respectively).In multivariate analysis,increased LDH level was identified as an independent prognostic factor for overall survival.Therefore,we conclude that increased pretreatment serum LDH and ALP levels are poor prognostic factors for NPC.

关键词：血清酶 LDH 鼻咽癌 ALP 预后治疗乳酸脱氢酶碱性磷酸酶

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Concurrent chemoradiotherapy with weekly docetaxel versus cisplatin in the treatment of locoregionally advanced nasopharyngeal carcinoma:a propensity score-matched analysis

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Cancer Communications 2019年第1期39卷 368-378页

作者： Jun-Fang Liao Qun Zhang xiao-Jing Du Mei Lan Shan Liu yun-fei xia Xiu-Yu Cai Wei Luo Department of Radiation Oncology National Cancer Center/Cancer Hospital&Shenzhen HospitalShenzhen 518116GuangdongP.R.China Department of Radiation Oncology The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510080GuangdongP.R.China State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer MedicineSun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China Department of Radiation Oncology State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China Department of Radiation Oncology Cancer Hospital Affiliated to School of MedicineChengdu 610041SichuanP.R.China Department of VIP Region Sun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China

Background:Promising efficacy and manageable toxicity of docetaxel-based concurrent chemoradiotherapy(CCRT)were reported in head and neck cancer.In addition,the effect of CCRT in combination with cisplatin and/or 5-fluorouracil on both locoregionally advanced and metastatic/recurrent nasopharyngeal carcinoma(NPC)was verified.However,CCRT with docetaxel for locoregionally advanced NPC are not well studied.This study aimed to compare effectiveness and toxicities of CCRT with weekly docetaxel versus tri-weekly cisplatin for locoregionally advanced NPC.Methods:Clinical data of patients with locoregionally advanced NPC newly diagnosed between January 2010 and December 2014 receiving CCRT with either weekly docetaxel(15 mg/m2)or tri-weekly cisplatin(80-100 mg/m2)were reviewed.Propensity score matching at a 1:1 ratio was performed to balance baseline characteristics.Adverse events and survival were compared between the two groups.Results:A total of 962 patients were included as the whole cohort,and 448 patients were matched and were regarded as the matched cohort.The median follow-up duration was 48 months for the whole cohort.The 3-year nodal recurrence-free survival rate was significantly increased for patients treated with docetaxel in both the whole(hazard ratio[HR]=0.37,95%confidence interval[CI]0.19-0.72,P=0.030)and matched cohorts(HR=0.33,95%CI 0.14-0.79,P=0.023).However,no significant differences were observed in overall survival,local recurrence-free survival,and distant metastasis-free survival between the two groups in both cohorts.Significantly higher rates of grade 3 radiodermatitis(6.7%vs.1.8%,P=0.001),mucositis(74.5%vs.37.9%,P<0.001),and leucopenia(2.2%vs.11.6%,P<0.001)were observed in the docetaxel group,but any grade of renal injury(1.8%vs.15.1%,P<0.001),vomiting(18.8%vs.88.3%,P<0.001),and ALT elevation(19.2%vs.31.3%,P=0.027)were more common in the cisplatin group.Conclusions:CCRT with weekly low-dose docetaxel is an effective and tolerable therapeutic regimen for locally advanced NPC.It provides a surv

关键词： Concurrent chemoradiotherapy Docetaxel Cisplatin Nasopharyngeal carcinoma Propensity score matching Intensity-modulated radiotherapy Overall survival Distant metastasis-free survival Locoregional recurrence-free survival Nodal recurrence-free survival

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Establishment and characterization of a novel nasopharyngeal carcinoma cell line (SUNE2) from a Cantonese patient

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Chinese Journal of Cancer 2012年第1期31卷 36-44页

作者： Ju-Qin Dong Man-Zhi Li Zhi-Gang Liu Qian Zhong Dan Xiong Li-Hua Xu Yong Du yun-fei xia Mu-Sheng Zeng State Key Laboratory of Oncology in South China GuangzhouGuangdong 510060P.R.China Department of Experimental Research Department of Radiation Therapy Sun Yat-sen University Cancer CenterGuangzhouGuangdong 510060P.R.China.

The undifferentiated form of nasopharyngeal carcinoma (NPC) is the most common malignant head and neck cancer in South China, especially in Cantonese populations. However, few NPC cell lines have been established from the patients in this region. In this study, we established a new NPC cell line, termed SUNE2, from a Cantonese patient with undifferentiated NPC. This cell line had extremely low concentrations of Epstein-Barr virus (EBV) DNA in long-term culture and expressed low levels of latent membrane protein 1 (LMP1), latent membrane protein 2A (LMP2A), BamH1-A right frame 1 (BARF1), EBV-encoded RNA-1 (EBER1), and EBV-encoded RNA-2 (EBER2) in early passages. SUNE2 cells also showed much stronger transforming ability than 5-8F cells in colony formation assays and anchorage- independent growth assays in soft agar, and they only need 2 weeks to form tumors in nude mice. In summary, the SUNE2 cell line is a new in vitro model that can be used for further research on the mechanisms underlying the occurrence and development of NPC.

关键词：细胞株鼻咽癌潜伏膜蛋白1 粤语表征 EB病毒恶性肿瘤生长实验

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Forty-six cases of nasopharyngeal carcinoma treated with 50 Gy radiotherapy plus hematoporphyrin derivative:20 years of follow-up and outcomes from the Sun Yat-sen University Cancer Center

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Chinese Journal of Cancer 2016年第6期35卷 53-62页

作者： Bing-Qing Xu Zi-Wei Tu Ya-Lan Tao Zhi-Gang Liu xiao-Hui Li Wei Yi Chang-Bing Jiang yun-fei xia State Key Laboratory of Oncology in South China Department of Radiation OncologyCollaborative Innovation Center for Cancer MedicineSun Yat-sen University Cancer Center651 Dongfeng East RoadGuangzhou 510060GuangdongPRChina Department of Radiation Oncology The First Affiliated Hospital of Guangzhou Medical UniversityGuangzhou 510060GuangdongPRChina

Background:With the improved overall survival(OS) of nasopharyngeal carcinoma(NPC) patients,the importance of quality of life(Qo L) is increasingly being recognized.For some radiosensitive NPC patients,whether low?dose radio?therapy can improve the Qo L without affecting clinical efficacy is unknown.This study aimed to assess the survival rates and Qo L of NPC patients treated with 50 Gy radiotherapy plus hematoporphyrin derivative(HPD).Methods:Forty?six newly diagnosed NPC patients treated with 50 Gy radiotherapy plus HPD between June 1988 and July 1992 were analyzed.All patients were restaged according to the 7th edition of the American Joint Commit?tee on Cancer staging system.The radiotherapy plan was designed on the basis of pretreatment computed tomog?raphy.The OS,local recurrence?free survival(LRFS),distant metastasis?free survival(DMFS),and disease?free survival(DFS) rates were estimated using the Kaplan–Meier method.Qo L was assessed using the Late Radiation Morbidity Scoring Criteria of the Radiation Therapy Oncology Group.Results:The 5?year OS,LRFS,DMFS,and DFS rates were 74.3%,72.6%,82.1%,and 61.2%,respectively.The corre?sponding 10?year rates were 38.4%,62.9%,78.5%,and 49.8%,respectively,and the 20?year rates were 27.7%,51.4%,78.5%,and 40.7%,respectively.None of the patients developed severe radiation?related complications,such as radiation?induced temporal lobe necrosis,hearing loss,trismus,and dysphagia.Conclusion:Some NPC patients were sensitive to 50 Gy radiotherapy plus HPD,and this sensitivity was characterized by long?term survival without significant late treatment morbidities.

关键词： Low-dose radiotherapy Nasopharyngeal carcinoma Radiosensitivity Quality of life

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Primary site and regional lymph nodeinvolvement are independent prognosticfactors for early？stage extranodal nasal？typenatural killer/T cell lymphoma

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Chinese Journal of Cancer 2016年第5期35卷 255-263页

作者： Shao‑Qing Niu Yong Yang Yi‑Yang Li Ge Wen Liang Wang Zhi‑Ming Li Han‑Yu Wang Lu‑Lu Zhang yun‑fei xia Yu‑Jing Zhang State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer MedicineSun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China Department of Radiation Oncology Sun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China Department of Radiation Oncology The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510060GuangdongP.R.China Department of Radiation Oncology Cancer Hospital and InstitutePeking Union Medical College(PUMC)and Chinese Academy of Medical Sciences(CAMS)Beijing 100021P.R.China Department of Nuclear Medicine The Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhou 510150GuangdongP.R.China Department of Hematological Oncology Sun Yatsen University Cancer CenterGuangzhou 510060GuangdongP.R.China Department of Medical Oncology Sun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China

Background:Nasal-type extranodal natural killer/T-cell lymphoma(ENKTCL) originates primarily in the nasal cavity or extra-nasal sites within the upper aerodigestive tract.However,it is unclear whether the primary site can serve as an independent prognostic factor or whether the varying clinical outcomes observed with different primary sites can be attributed merely to their propensities of regional lymph node involvement.The aim of this study was to investigate the prognostic implications of the primary site and regional lymph node involvement in patients with early-stage nasal-type ENKTCL.Methods:To develop a nomogram,we reviewed the clinical data of 215 consecutively diagnosed patients with early-stage nasal-type ENKTCL who were treated in Sun Yat-sen University Cancer Center with chemotherapy and radiotherapy between 2000 and 2011.The predictive accuracy and discriminative ability of the nomogram were determined using a concordance index(C-index) and calibration curve.Results:The 5-year overall survival(OS) and progression-free survival(PFS) rates of patients with nasal ENKTCL were higher than those of patients with extra-nasal ENKTCL(OS:68.2%vs.46.0%,P = 0.030;PFS:53.4%vs.26.6%,P = 0.010).The 5-year OS and PFS rates of patients with Ann Arbor stage IE ENKTCL were higher than those of patients with Ann Arbor stage HE ENKTCL(OS:66.3%vs.59.2%,P = 0.003;PFS:51.4%vs.40.3%,P = 0.009).Multivariate analysis showed that age >60 years,ECOG performance status score >2,elevated lactate dehydrogenase(LDH) level,extranasal primary site,and regional lymph node involvement were significantly associated with lower 5-year OS rate;age >60 years,elevated LDH level,extra-nasal primary site,and regional lymph node involvement were significantly associated with lower 5-year PFS rate.The nomogram included the primary site and regional lymph node involvement based on multivariate analysis.The calibration curve showed good agreement between the predicted and actual 5-year OS and PFS rates,and the C-indexes of the nomogram for the OS a

关键词： Extranodal natural killer/T-cell lymphoma (ENKTCL), Nasal cavity, Lymph node, Prognosis, Nomogram

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Subdivision of M category for nasopharyngeal carcinoma with synchronous metastasis:time to expand the M categorization system

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Chinese Journal of Cancer 2015年第10期34卷 450-483页

作者： Lu-Jun Shen Si-Yang Wang Guo-Feng Xie Qi Zeng Chen Chen An-Nan Dong Zhi-Mei Huang Chang-Chuan Pan yun-fei xia Pei-Hong Wu Department of Medical Imaging and Interventional Radiology Sun Yat-sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer Medicine Department of Radiation Oncology The Fifth Affiliated Hospital of Sun Yat-sen University Department of Radiation Oncology Cancer Center of Guangzhou Medical University Department of Radiation Oncology Sun Yat-sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer Medicine Department of Medical Oncology Sichuan Cancer Hospital and Institute

Introduction:The current metastatic category(M) of nasopharyngeal carcinoma(NPC) is a "catch-all" classification,covering a heterogeneous group of tumors ranging from potentially curable to incurable.The aim of this study was to design an M categorization system that could be applied in planning the treatment of NPC with synchronous metastasis.Methods:A total of 505 NPC patients diagnosed with synchronous metastasis at Sun Yat-sen University Cancer Center between 2000 and 2009 were involved.The associations of clinical variables,metastatic features,and a proposed M categorization system with overall survival(OS) were determined by using Cox regression model.Results:Multivariate analysis showed that Union for International Cancer Control(UICC) N category(N1-3/N0),number of metastatic lesions(multiple/single),liver involvement(yes/no),radiotherapy to primary tumor(yes/no),and cycles of chemotherapy(>4/<4) were independent prognostic factors for OS.We defined the following subcategories based on liver involvement and the number of metastatic lesions:Mia,single lesion confined to an isolated organ or location except the liver;Ml b,single lesion in the liver and/or multiple lesions in any organs or locations except the liver;and M1 c,multiple lesions in the liver.Of the 505 cases,74(14.7%) were classified as Mia,296(58.6%)as M1 b,134(26.5%) as M1 c,and 1 was not specified.The three Ml subcategories showed significant difference in OS[Ml b vs.Mia,hazard ratio(HR) = 1.69,95%confidence interval(CI) = 1.16-2.48,P = 0.007;Ml c vs.Ml a,HR = 2.64,95%CI = 1.75-3.98,P< 0.001],Conclusions:We developed an M categorization system based on the independent factors related to the prognosis of patients with metastatic NPC.This system may be helpful to further optimize individualized care for NPC patients.

关键词： Nasopharyngeal carcinoma, TNM staging, Metastasis, Prognosis

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