准确的分期是治疗全球鼻咽癌 (NPC) 患者的基本步骤；这不仅对于预测至关重要，而且对于指导治疗决策也至关重要。美国癌症联合委员会 (AJCC)/国际癌症控制联盟 (UICC) 肿瘤-淋巴结-转移 (TNM) 系统是临床医生、研究人员和癌症登记处的全球语言。与当代护理模式保持一致的持续改进至关重要。为了提高第八版 (TNM-8) NPC 的预后准确性和临床适用性。这项多中心研究分析了 2014 年 1 月和 2015 年 12 月期间具有详细肿瘤特征的 NPC 患者，由经验丰富的放射科医生审查。数据分析于2023年12月完成。研究结果通过内部和外部验证得到进一步证实。 AJCC/UICC 多学科头颈专家组对统计分析和临床考虑因素进行了审查，并达成了共识。这些建议在最终认可为第九版 (TNM-9) 之前由 AJCC 循证医学委员会进行了评估。主要终点是总生存期。然后评估不同亚组的调整后风险比，以确认最佳分期分组。在分析的 4914 名患者中，1264 名 (25.7%) 为女性，3650 名 (74.3%) 为男性；中位年龄 (SD) 为 48.1 (12.0) 岁。晚期放射学结外扩展（涉及邻近肌肉、皮肤和/或神经血管束）被确定为所有终点的独立不利因素：这被添加为 N3 的标准。非转移性疾病患者被重新分为 I ​​至 III 期，而不是 TNM-8 I 至 IVA 期。通过将 T1-2N0-1 分组为 I 期、T3/N2 分组为 II 期、T4/N3 分组为 III 期，实现了显着的危险区分。尽管 T1-2N0-1 亚组的 5 年总生存率相当，但由于调整化疗使用后调整后的风险比存在差异，建议将其细分为 IA (T1-T2N0) 和 IB (T1-T2N1)。转移性疾病被专门分类为 IV 期，并通过细分为 IVA（M1a，≤ 3 个病灶）和 IVB（M1b，> 3 个病灶）进一步细化预后。与 TNM-8 相比，TNM-9 在主要统计方面表现出优越性。这项诊断研究的结果表明，第九版 NPC TNM 分期基于稳健的分析和 AJCC/UICC 分期委员会的全面审查，提供了改进了全球应用的分期系统以及未来纳入非解剖因素的框架。该项目将于 2025 年 1 月推出全球应用。

Accurate staging is a fundamental step in treating patients with nasopharyngeal carcinoma (NPC) worldwide; this is crucial not only for prognostication, but also for guiding treatment decisions. The American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) tumor-node-metastasis (TNM) system is the global language for clinicians, researchers, and cancer registries. Continual improvement that aligns with contemporary pattern of care is essential.To improve the prognostic accuracy and clinical applicability of the eighth edition (TNM-8) for NPC.This multicenter study analyzed patients with NPC with detailed tumor features during January 2014 and December 2015 and was reviewed by experienced radiologists. The data analysis was completed in December 2023. The findings were further confirmed with internal and external validation. Statistical analyses and clinical considerations were reviewed by the AJCC/UICC multidisciplinary head and neck panels and attained consensus. The recommendations were evaluated by the AJCC Evidence-Based Medicine Committee before final endorsement as the ninth version (TNM-9).The primary end point was overall survival. Adjusted hazard ratios of different subgroups were then assessed for confirmation of optimal stage grouping.Of the 4914 patients analyzed, 1264 (25.7%) were female and 3650 (74.3%) were male; the median (SD) age was 48.1 (12.0) years. Advanced radiological extranodal extension (with involvement of adjacent muscles, skin, and/or neurovascular bundles) was identified as an independent adverse factor for all end points: this was added as a criterion for N3. Patients with nonmetastatic disease were regrouped into stages I to III instead of TNM-8 stages I to IVA. Significant hazard discrimination was achieved by grouping T1-2N0-1 as stage I, T3/N2 as stage II, and T4/N3 as stage III. Although the T1-2N0-1 subgroups had comparable 5-year overall survival, subdivisions into IA (T1-T2N0) and IB (T1-T2N1) were recommended due to the distinction in adjusted hazard ratios following adjustment for chemotherapy use. Metastatic disease was exclusively classified as stage IV, and prognostication was further refined by subdivision into IVA (M1a, ≤3 lesions) and IVB (M1b, >3 lesions). TNM-9 demonstrated superiority compared with TNM-8 in major statistical aspects.The results of this diagnostic study suggest that the ninth version of TNM staging for NPC, based on robust analyses and a comprehensive review by the AJCC/UICC staging committees, provides an improved staging system for global application and a framework for future incorporation of nonanatomical factors. This will be launched for global application in January 2025.