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Scientific Oral Presentation

Head and Neck Surgery

AJCC 9th Edition Staging for Nasopharyngeal Carcinoma in the United States: Perspectives from the NCDB

Sunday, October 18, 2026
9:30 AM - 9:36 AM PT
Location: West Exhibit Hall A, Learning Zone 3

    Presenting Author(s)

  • Praneet C. Kaki, BS

    Medical Student
    Sidney Kimmel Medical College Thomas Jefferson University
    Philadelphia, PA, United States

    • Co-Author(s)

  • NS

    Neel Sangal, MD

    Dr.
    Children's Hospital of Philadelphia, United States

  • SM

    Shahzara Malik, MD Candidate

    Medical Student
    College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates., United States

    • Senior Author(s)

  • Robert M. Brody, MD

    Associate Professor of Otorhinolaryngology
    University of Pennsylvania
    Philadelphia, Pennsylvania, United States

Disclosure(s):
Praneet C. Kaki, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The AJCC recently introduced the 9th Edition TNM (9E) staging system for nasopharyngeal carcinoma (NPC), incorporating major revisions, including stage redistribution and the inclusion of advanced extranodal extension (ENE). These updates were derived from studies focusing on endemic NPC populations, but their prognostic utility within a diverse United States cohort remains unstudied. This study evaluates the changes inherent to and the outcomes of NPC with AJCC 9E staging system using the National Cancer Database (NCDB).

Methods: Patients diagnosed with NPC between 2010-2020 were identified from the NCDB. Overall stage was assigned according to both AJCC 8th (8E) and 9th edition clinical staging criteria. Kaplan-Meier analysis was used to compare five-year overall survival (OS) across stages using the 8th and 9th edition guidelines, respectively. Multivariable Cox proportional hazards regression was performed to compare predictive value of stage between 8E and 9E.

Results: A total of 12,058 patients were included. Stage distribution differed between the AJCC 8th and 9th editions: 7.9% of patients were stage I in 8E which were split into 11.4% (IA) and 14.6% (IB) in 9E, while stage IV disease decreased from 36.5% to 8.7%. OS using 8th edition was 62.8% (I), 69.8% (II), 59.7% (III), and 42.1% (IV). Using the 9th edition, OS was 66.7% (IA), 76.1% (IB), 63.9% (II), 48.8% (III), and 22.4% (IV) (p < 0.0001). Patients with ENE had lower OS compared to those without ENE (59.9% vs 62.2%, p=0.033). On multivariable Cox regression using the 9th edition, stages II (aHR 1.46, 95% CI 1.23-1.74), III (2.44, [2.07-2.88]), and IV (4.36, [3.57-5.31]) showed significantly greater prognostication than 8th edition stages II (0.96, [0.77 - 1.20]), III (1.60, [1.31 -1.95]), and IV (2.67 [2.20 - 3.25]).

Conclusions: The AJCC 9E system for NPC demonstrates improved prognostic stratification compared to the 8E in the United States population. However, differences in how ENE is defined and specific population characteristics should be considered when applying these guidelines outside endemic regions.