{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T10:25:07Z","timestamp":1794219907744,"version":"4.8.0"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The aim of this study was to develop and validate a novel surgical T (sT) staging system for recurrent nasopharyngeal carcinoma (rNPC) that better reflects anatomical barriers to resection and improves prognostic accuracy compared with the American Joint Committee on Cancer (AJCC) staging system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Cadaveric dissections and a retrospective analysis of 211 patients with rNPC undergoing endoscopic nasopharyngectomy were conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The proposed sT staging system incorporates 3 key anatomical barriers\u2014the pharyngobasilar fascia (PBF), interpterygoid fascia (IPF), and dura mater\u2014to stratify rNPC into 4 stages (sT1\u2013sT4). In a retrospective cohort of 211 patients who underwent endoscopic nasopharyngectomy, the 5-year overall survival (OS) rates based on AJCC rT staging were 92.9% (rT1), 72.9% (rT2), 69.3% (rT3), and 37.1% (rT4). In contrast, the 5-year OS rates under the sT staging system were 93.4% (sT1), 80.3% (sT2), 60.0% (sT3), and 34.0% (sT4), demonstrating improved separation of survival outcomes across stages (p &lt; 0.001). In the held-out validation cohort under a hash-locked 80\/20 split, the sT model achieved superior discrimination compared with AJCC rT (C-index, 0.624 vs 0.546; 2-year time area under the curve [AUC] 0.709 [simple\/IPCW 0.709\/0.740] vs 0.632 [0.632\/0.667]) with acceptable calibration at 2\u20134 years. The 5-year AUC was not estimable because no patients remained event free beyond 5 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>By encoding barrier-guided spread aligned with endoscopic resectability (PBF, IPF, and dura), the sT system improves external discrimination and stage separation, thereby enhancing preoperative risk stratification and surgical planning. External, multi-institutional validation with longer follow-up is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.1.jns251258","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:01:04Z","timestamp":1782259264000},"page":"777-785","source":"Crossref","is-referenced-by-count":0,"title":["A novel surgical T staging system for recurrent nasopharyngeal carcinoma: advancing prognostic accuracy and clinical applicability"],"prefix":"10.3171","volume":"145","author":[{"given":"Huankang","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaole","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingyi","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Eye & ENT Hospital, Fudan University, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shixing","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanpeng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuting","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuzhen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengle","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingjin","family":"Weng","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai;"},{"name":"Department of Otorhinolaryngology, The People\u2019s Hospital of Guangxi Zhuang Autonomous Region, Guangxi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai;"},{"name":"Department of Otorhinolaryngology, The First Affiliated Hospital, Xinjiang Medical University, Xinjiang;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai;"},{"name":"Department of Otolaryngology, Chengdu First People\u2019s Hospital, Chengdu;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai;"},{"name":"Department of Otorhinolaryngology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ru","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai;"},{"name":"Department of Otolaryngology, The Third Xiangya Hospital of Central South University, Changsha, Hunan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Ye","sequence":"additional","affiliation":[{"name":"Clinical Research Center, Eye & ENT Hospital, Fudan University, Shanghai; 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