{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T06:04:58Z","timestamp":1789452298119,"version":"build-2803163510"},"reference-count":26,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>TNM\u20109 Stage IB nasopharyngeal carcinoma (NPC) encompasses markedly heterogeneous risk profiles, yet lacks reliable biomarkers to guide the choice between de\u2010escalation and intensification strategies. This study aimed to explore the prognostic significance of upper\u2010 and middle\u2010neck nodal involvement (UNI and MNI) in this population and how it affects treatment outcomes and prognosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with Stage IB NPC treated between June 2016 and December 2019 at our institution were included. Nodal levels were classified into UNI and MNI. Survival outcomes, including overall survival (OS), progression\u2010free survival (PFS), distant control (DC), and regional control (RC), were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 370 patients were analyzed, with 257 (69.5%) classified in the UNI group and 113 (30.5%) in the MNI group, respectively. MNI was found to be associated with significantly worse prognosis compared to UNI. Specifically, the MNI group had lower 5\u2010year OS (91.1% vs. 98.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), PFS (78.6% vs. 95.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), DC (90.2% vs. 98.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and RC (93.3% vs. 98.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005) than the UNI group. Association analysis revealed that nodal level was significantly associated with other known adverse prognostic factors, including the maximum diameter of positive lymph nodes, matted nodes, and high EBV\u2010DNA levels (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Crucially, after multivariate adjustment, nodal level is the only independent prognostic factor.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The nodal level was a critical factor in predicting patient outcomes in Stage IB NPC. These findings are hypothesis\u2010generating: UNI patients may represent a candidate population for prospective de\u2010escalation trials, whereas MNI patients may warrant evaluation of intensified or novel strategies in future studies. Prospective validation is required before any change in clinical management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.72166","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T07:27:45Z","timestamp":1786001265000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Upper Versus Middle\u2010Neck Involvement in\n                    <scp>TNM<\/scp>\n                    \u20109 Stage\n                    <scp>IB<\/scp>\n                    Nasopharyngeal Carcinoma: Implications for De\u2010Escalation and Intensification Strategies"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0628-9082","authenticated-orcid":false,"given":"Hanchuan","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital  Fuzhou Fujian 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School of Fujian Medical University, Fujian Cancer Hospital  Fuzhou Fujian China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital  Fuzhou Fujian China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yahan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital  Fuzhou Fujian China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6207-381X","authenticated-orcid":false,"given":"Ziyi","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital  Fuzhou Fujian 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