International Collaborative Study on AJCC/UICC TNM-10 for Nasopharyngeal Cancer

Nasopharyngeal carcinoma (NPC) is an Epstein-Barr virus-associated malignancy with a striking geographical predominance, over 70% of global cases occur in East and Southeast Asia. The current AJCC/UICC TNM Version-Nine staging system, launched in January 2025, is a significant advancement in prognostic stratification. The recommendations are based by high quality retrospective data from Mainland China and Hong Kong and consensus building among international multidisciplinary experts, taking into consideration both the statistical evidence of benefit and clinical applicability.

Recent years have witnessed transformative changes in NPC treatment paradigms, including advancements in radiotherapy techniques, the integration of immune checkpoint inhibitors, and intensified treatment for metastatic disease. In addition, studies have demonstrated the independent prognostic value of non-anatomical factors such as circulating Epstein-Barr virus (EBV) DNA levels, and various hematologic biomarkers. These developments necessitate continual improvement of the TNM staging system to align with contemporary management with diagnostic and therapeutic advancements.

This international, multicenter, prospective observational study is designed to address these critical requirements to generate high-quality evidence for developing the next generation TNM staging system (AJCC/UICC Version-Ten). The study will enroll all consecutive histopathological confirmed NPC patients treated during October 2025 and September 2026 from leading cancer centers worldwide. Detailed data on clinicopathological characteristics, imaging findings, molecular markers (including EBV-DNA), treatment and outcome will be collected and analyzed.

The primary endpoint of the study is overall survival (OS), while secondary endpoints focus on the pattern of failure at different sites: local failure-free survival (L-FFS), regional nodal failure-free survival (N-FFS), and distant failure-free survival (D-FFS). Correlation of these outcomes to anatomical and non-anatomical factors will be analyzed.

This study will be another important milestone for NPC staging because firstly, this is the first time that the data are based on prospective data to ensure comprehensive coverage of all essential evidence; and secondly, this is the first time that centers from non-endemic countries/regions will also participate to ensure that the final recommendations are globally applicable. The findings will provide valuable evidence for the development of the AJCC/UICC TNM Version-Ten staging system and prognostic system to improve risk stratification for designing personalized treatment strategy, ultimately leading to improvement of patient outcome and patient selection for future research worldwide.

Inclusion criteria

• All histologically confirmed nasopharyngeal carcinoma treated between 1 Oct 2025 and 30 Sep 2026

Exclusion criteria

• Non-epithelial tumors of nasopharynx (including lymphoma, sarcoma of soft tissue, bone/cartilagetumors. mucosal melanoma, salivary type tumors)