We aimed to investigate whether the number of metastatic lymph nodes (LNs) is an independent prognostic factor for progression-free survival (PFS) in nasopharyngeal carcinoma (NPC) and to establish a new N staging system based on the number of positive LNs on magnetic resonance imaging. In 792 NPC patients, we found that the number of metastatic LNs was the only independent prognostic factor for PFS following multivariate analysis. We categorized the number of metastatic LNs into 4 groups to create a new N staging system which was more effective than the American Joint Committee on Cancer staging system for predicting PFS.
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