Refining the 8th edition TNM classification for EBV related nasopharyngeal carcinoma

The AJCC/UICC TNM classification describes anatomic extent of tumor progression and guides treatment decisions. Our comprehensive analysis of 8,834 newly diagnosed patients with non-metastatic Epstein-Barr virus related nasopharyngeal carcinoma (NPC) from six Chinese centers indicates certain limitations in the current staging system. The 8th edition of the AJCC/UICC TNM classification inadequately differentiates patient outcomes, particularly between T2 and T3 categories and within the N classification. We propose reclassifying cases of T3 NPC with early skull-base invasion as T2, and elevating N1-N2 cases with grade 3 image-identified extranodal extension (ENE) to N3. Additionally, we suggest combining T2N0 with T1N0 into a single stage IA. For de novo metastatic (M1) NPC, we propose subdivisions of M1a, defined by 1–3 metastatic lesions without liver involvement, and M1b, characterized by >3 metastatic lesions or liver involvement. This proposal better reflects responses of NPC patients to the up-to-date treatments and their evolving risk profiles. [Display omitted] •T3 NPC with early skull invasion-only is reclassified as T2•N1-N2 with grade 3 image-identified ENE is reclassified as N3•T2N0 and T1N0 are merged to a single stage IA•M1 subdivides to M1a (1–3 lesions, none in liver) and M1b (>3 lesions or liver met) Du et al. develop a refinement for the current 8th editor of AJCC/UICC TNM staging system for Epstein-Barr virus (EBV) related nasopharyngeal carcinoma. This proposal offers several advancements including improved hazard discrimination, enhanced hazard consistency, better sample size balance, and superior outcome prediction. Additionally, it is more in line with contemporary therapeutic strategies.