Shi Qi, Shen Chunying, Kong Lin, Wang Xiaoshen, Ding Jianhui, Gao Yunsheng, Xu Tingting, Hu Chaosu
Department of Radiation Oncology, Cancer Hospital of Fudan University, 270 Dong An Road, Shanghai, China.
Radiat Oncol. 2014 Jan 6;9:7. doi: 10.1186/1748-717X-9-7.
The N1 definition of 2010 UICC/AJCC staging system for nasopharyngeal carcinoma (NPC) covers quite a large range of nodal pattern. The objective of this research is to investigate prognostic value of lymph nodes related factors including involvement of both cervical lymph nodes (CLNs) and retropharyngeal lymph nodes (RLNs) or not, size and number of cervical lymph nodes (CLNs) in N1 patients with NPC.
142 newly diagnosed non-metastatic N1 patients with NPC, staged according to the 2010 AJCC staging system for NPC were retrospectively enrolled. All patients had undergone contrast-enhanced magnetic resonance imaging (MRI), and received radiotherapy, with or without chemotherapy as their primary treatment.
The median follow-up was 48 months. The 5-year local recurrence-free survival (LFS), nodal recurrence-free survival (NFS), local-regional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) of the whole group were 82.3%, 83.0%, 81.0%, 82.1%, 75.3% and 89.8%, respectively. In univariate analysis, patients with both CLNs and RLNs involvement showed a significant lower DMFS, PFS and LRFS than the rest patients (p=0.004 p=0.003 and p=0.034, respectively). Neither size nor number of CLNs affected the survival. In multivariate analysis, involvement of both CLNs and RLNs was an independent prognostic factor for DMFS and PFS (p=0.019, p=0.019), but there was no enough evidence confirming its prognostic value for LRFS (p=0.051).
For N1 patients with NPC, involvement of both RLNs and CLNs may be a potentially prognostic factor for distant metastasis and disease progression. The N stage for N1 patients with involvement of both cervical lymph nodes and retropharyngeal lymph nodes might need to be deliberated.
2010年国际抗癌联盟（UICC）/美国癌症联合委员会（AJCC）鼻咽癌分期系统中的N1定义涵盖了相当广泛的淋巴结模式。本研究的目的是探讨淋巴结相关因素对鼻咽癌N1期患者的预后价值，这些因素包括双侧颈部淋巴结（CLN）和咽后淋巴结（RLN）是否受累、颈部淋巴结（CLN）的大小和数量。
回顾性纳入142例新诊断的非转移性鼻咽癌N1期患者，根据2010年AJCC鼻咽癌分期系统进行分期。所有患者均接受了增强磁共振成像（MRI）检查，并接受了放疗，部分患者接受了化疗作为主要治疗手段。
中位随访时间为48个月。全组患者的5年局部无复发生存率（LFS）、区域无复发生存率（NFS）、局部区域无复发生存率（LRFS）、远处转移无复发生存率（DMFS）、无进展生存率（PFS）和总生存率（OS）分别为82.3%、83.0%、81.0%、82.1%、75.3%和89.8%。单因素分析显示，双侧CLN和RLN均受累的患者，其DMFS、PFS和LRFS显著低于其他患者（分别为p = 0.004、p = 0.003和p = 0.034）。CLN的大小和数量均不影响生存率。多因素分析显示，双侧CLN和RLN均受累是DMFS和PFS的独立预后因素（p = 0.019、p = 0.019），但尚无足够证据证实其对LRFS的预后价值（p = 0.051）。
对于鼻咽癌N1期患者，RLN和CLN均受累可能是远处转移和疾病进展的潜在预后因素。对于双侧颈部淋巴结和咽后淋巴结均受累的鼻咽癌N1期患者，N分期可能需要重新考量。
