Munck J N, Cvitkovic E, Piekarski J D, Benhamou E, Recondo G, Bachouchi M, Tellez-Bernal E, Luboinski B, Eschwege F, Wibault P
Department of Medicine, Institut Gustave Roussy, Villejuif, France.
J Natl Cancer Inst. 1991 Apr 17;83(8):569-75. doi: 10.1093/jnci/83.8.569.
Pretherapeutic identification of patients likely to benefit from neoadjuvant chemotherapy for head and neck epidermoid cancer is of interest. We retrospectively analyzed the pretherapeutic computed tomographic (CT) scans of lymph nodes of 70 patients with head and neck cancer. All 70 patients were clinically classified as having stage IV disease. The purpose of our analysis was to compare the prognostic value of CT node density with that of the following factors: age, T and N categories, Eastern Cooperative Oncology Group performance status, tumor site, histopathologic type of disease [squamous cell carcinoma (SCC) or undifferentiated carcinoma of nasopharyngeal type (UNCT)], and type of local-regional treatment. A simple two-grade nodal density grading system was devised. The density of normal adjacent muscle was chosen as the density standard. A node was classified grade 1 if less than 33% of the node consisted of hypodense zones. A node was classified grade 2 if more than 33% of the node consisted of hypodense zones. Patients with grade 1 nodes had a complete response rate of 68% (21/31) compared with 8% (3/39) for those with grade 2 nodes (P less than .0001). The only other factor associated with complete node response was UCNT (P less than .03). However, node density remained the significant prognostic factor after adjustment for histopathologic type. Follow-up ranged from 16 to 44 months, with a median of 29 months. Patients with grade 1 nodes had a median survival time of 32 months versus 13 months for those with grade 2 nodes (P less than .01). A prospective study should validate the prognostic value of CT node density and its possible use in determining optimal multimodal therapy for advanced head and neck cancers.
对头颈部表皮样癌患者进行治疗前评估，以确定哪些患者可能从新辅助化疗中获益，这一研究很有意义。我们回顾性分析了70例头颈部癌患者治疗前的淋巴结计算机断层扫描（CT）图像。所有70例患者临床分期均为IV期。我们分析的目的是比较CT淋巴结密度与以下因素的预后价值：年龄、T和N分类、东部肿瘤协作组（ECOG）体能状态、肿瘤部位、疾病的组织病理学类型[鳞状细胞癌（SCC）或鼻咽型未分化癌（UNCT）]以及局部区域治疗类型。我们设计了一个简单的两级淋巴结密度分级系统。选择相邻正常肌肉的密度作为密度标准。如果淋巴结低密度区占比小于33%，则将该淋巴结分类为1级。如果淋巴结低密度区占比超过33%，则将该淋巴结分类为2级。1级淋巴结患者的完全缓解率为68%（21/31），而2级淋巴结患者的完全缓解率为8%（3/39）（P<0.0001）。与淋巴结完全缓解相关的唯一其他因素是UNCT（P<0.03）。然而，在调整组织病理学类型后，淋巴结密度仍然是显著的预后因素。随访时间为16至44个月，中位随访时间为29个月。1级淋巴结患者的中位生存时间为32个月，而2级淋巴结患者为13个月（P<0.01）。一项前瞻性研究应验证CT淋巴结密度的预后价值及其在确定晚期头颈部癌最佳多模式治疗中的可能应用。
