Carcinoma of the nasopharynx--comparison of the UICC and Ho clinical staging systems

From 1974 to 1985 definitive radiation therapy was performed in 76 patients with nasopharyngeal carcinoma (NPC). Of the 76 patients 59 presented UICC stage IV and 13 UICC stage III. The distribution of the stages was more homogeneous for the Ho system: Ho I, n = 4; II, n = 21; III, n = 16; IV, n = 32; V, n = 3. Radiotherapy followed the guidelines of the M.D. Anderson Hospital in Houston. A median dose of 68 Gy was given to the primary and of 66 Gy to the neck nodes, independent of the histologic subtype. The 5-year actuarial survival rate was 41% and the disease specific relapse-free survival (r.f.s.) 45%. Analysis according to the UICC classification and Ho's classification showed obvious deficiencies in both staging systems, but did not result in major prognostic differences. The freedom from local relapses correlated (P less than 0.05) with the T categories of the UICC at presentation (75% in T1 vs 45% in T4) and the freedom from distant metastases was significantly influenced by the cervical status (fixed cervical lymph nodes (UICC N3) vs, e.g., UICC N2: 51% vs 90%; P less than 0.05). In case of supraclavicular lymph nodes (Ho IV; Kyoto C) the freedom of distant metastases was lower than in case of upper cervical lymph nodes (58% and 79%, respectively; P = 0.3).