放射性后咽部淋巴结转移对口咽癌的影响。
The impact of radiographic retropharyngeal adenopathy in oropharyngeal cancer.
机构信息
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
出版信息
Cancer. 2013 Sep 1;119(17):3162-9. doi: 10.1002/cncr.28195. Epub 2013 Jun 3.
BACKGROUND
We performed this study to define the incidence of radiographic retropharyngeal lymph node (RPLN) involvement in oropharyngeal cancer (OPC) and its impact on clinical outcomes, neither of which has been well established to date.
METHODS
Our departmental database was queried for patients irradiated for OPC between 2001 and 2007. Analyzable patients were those with imaging data available for review to determine radiographic RPLN status. Demographic, clinical, and outcome data were retrieved and analyzed.
RESULTS
The cohort consisted of 981 patients. The median follow-up was 69 months. The base of the tongue (47%) and the tonsil (46%) were the most common primary sites. The majority of patients had stage T1 to T2 primary tumors (64%), and 94% had stage 3 to 4B disease. Intensity-modulated radiation therapy was used in 77% of patients, and systemic therapy was administered in 58% of patients. The incidence of radiographic RPLN involvement was 10% and was highest for the pharyngeal wall (23%) and lowest for the base of the tongue (6%). RPLN adenopathy correlated with several patient and tumor factors. RPLN involvement was associated with poorer 5-year outcomes on univariate analysis (P<.001 for all) for local control (79% vs 92%), nodal control (80% vs 93%), recurrence-free survival (51% vs 81%), distant metastases-free survival (66% vs 89%), and overall survival (52% vs 82%) and maintained significance on multivariate analysis for local control (P = .023), recurrence-free survival (P = .001), distant metastases-free survival (P = .003), and overall survival (P = .001).
CONCLUSIONS
In this cohort of nearly 1000 patients investigating [corrected] radiographic RPLN adenopathy in OPC, RPLN involvement was observed in 10% of patients and portends [corrected] a negative influence on disease recurrence, distant relapse, and survival. In this cohort of nearly 1000 patients investigating radiographic RPLN adenopathy in OPC, RPLN involvement was observed in 10% of patients and portends a negative influence on disease recurrence, distant relapse, and survival.
背景
我们进行这项研究旨在确定口咽癌（OPC）患者中放射性咽后淋巴结（RPLN）受累的发生率及其对临床结局的影响，迄今为止，这两个方面都尚未得到充分证实。
方法
我们的科室数据库中检索了 2001 年至 2007 年期间接受 OPC 放疗的患者。可分析的患者是指有影像学数据可供审查以确定放射性 RPLN 状态的患者。我们检索并分析了人口统计学、临床和结局数据。
结果
该队列包括 981 名患者。中位随访时间为 69 个月。舌根（47%）和扁桃体（46%）是最常见的原发部位。大多数患者的原发肿瘤处于 T1 至 T2 期（64%），94%的患者处于 3 至 4B 期。77%的患者采用调强放疗，58%的患者接受了全身治疗。影像学 RPLN 受累的发生率为 10%，咽壁（23%）受累率最高，舌根（6%）受累率最低。RPLN 淋巴结病与多种患者和肿瘤因素相关。单因素分析显示，RPLN 受累与局部控制（79% vs 92%，P<.001）、淋巴结控制（80% vs 93%，P<.001）、无复发生存率（51% vs 81%，P<.001）、无远处转移生存率（66% vs 89%，P<.001）和总生存率（52% vs 82%，P<.001）的 5 年结局较差相关，多因素分析显示，局部控制（P = .023）、无复发生存率（P = .001）、无远处转移生存率（P = .003）和总生存率（P = .001）均具有统计学意义。
结论
在这项近 1000 例调查 OPC 患者放射性 RPLN 淋巴结病的研究中，10%的患者出现了 RPLN 受累，这预示着疾病复发、远处复发和生存的负面影响。
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