Chan Sheng-Chieh, Lin Chien-Yu, Ng Shu-Hang, Chang Joseph T, Wang Hung-Ming, Liao Chun-Ta, Lo Chuan-Wei, Yen Tzu-Chen
Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
Nucl Med Commun. 2010 Mar;31(3):260-5. doi: 10.1097/MNM.0b013e3283360133.
Retropharyngeal lymph node (RPLN) metastasis is a poor prognosticator in oropharyngeal and hypopharyngeal cancers. The purpose of this study is to evaluate the impact of F-fluorodeoxyglucose positron emission tomography (F-FDG PET) on the diagnosis and predictor analysis of RPLN in these cancers.
We enrolled patients with oropharyngeal and hypopharyngeal cancers before receiving definitive treatment. Staging was performed by F-FDG PET and conventional imaging modalities. Differences in RPLN metastasis detection rates were compared. Independent predictors of RPLN involvement were also assessed.
A total of 224 patients were investigated. RPLN involvement was identified in 17% of the study patients. In 18% of the 38 patients with RPLN involvement, RPLN metastases were identified by F-FDG PET only. Only 4% of the patients with oropharyngeal cancer and RPLN metastasis were not identified without the use of F-FDG PET, compared with 46% of patients with hypopharyngeal cancer. In multivariate analysis, posterior pharyngeal wall tumor (P=0.02) or the presence of ipsilateral level V lymph node metastasis (P=0.025) were independent predictors of RPLN involvement in hypopharyngeal cancer. In oropharyngeal cancer, no factors retained their independent significance.
We concluded that F-FDG PET is helpful in detecting RPLN metastasis in hypopharyngeal cancer. The presence of ipsilateral level V lymph node metastasis or tumors originating from the posterior pharyngeal wall can predict RPLN involvement in hypopharyngeal cancer and might represent an indication for elective irradiation of this nodal basin. However, regional lymph node involvement is not an independent predictor in oropharyngeal cancer. The predictor for RPLN metastasis seems to change after the introduction of PET.
咽后淋巴结（RPLN）转移是口咽癌和下咽癌预后不良的指标。本研究旨在评估F-氟脱氧葡萄糖正电子发射断层扫描（F-FDG PET）对口咽癌和下咽癌中RPLN的诊断及预测分析的影响。
我们纳入了在接受确定性治疗前的口咽癌和下咽癌患者。通过F-FDG PET和传统成像方式进行分期。比较RPLN转移检出率的差异。还评估了RPLN受累的独立预测因素。
共调查了224例患者。17%的研究患者发现有RPLN受累。在38例有RPLN受累的患者中，18%仅通过F-FDG PET发现有RPLN转移。在口咽癌伴RPLN转移的患者中，不使用F-FDG PET时仅4%未被发现，而下咽癌患者中这一比例为46%。多因素分析显示，下咽癌中咽后壁肿瘤（P = 0.02）或同侧Ⅴ区淋巴结转移（P = 0.025）是RPLN受累的独立预测因素。在口咽癌中，没有因素保留其独立意义。
我们得出结论，F-FDG PET有助于检测下咽癌中的RPLN转移。同侧Ⅴ区淋巴结转移或起源于咽后壁的肿瘤可预测下咽癌中的RPLN受累，可能代表该淋巴结区域选择性放疗的指征。然而，区域淋巴结受累在口咽癌中不是独立的预测因素。引入PET后，RPLN转移的预测因素似乎发生了变化。
