Wang Hong-Zhi, Cao Cai-Neng, Luo Jing-Wei, Yi Jun-Lin, Huang Xiao-Dong, Zhang Shi-Ping, Wang Kai, Qu Yuan, Xiao Jian-Ping, Li Su-Yan, Gao Li, Xu Guo-Zhen
Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Science, Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
Radiat Oncol. 2016 Sep 1;11(1):113. doi: 10.1186/s13014-016-0691-x.
Although parotid-sparing IMRT decreased the dose distribution of parotid, parotid region recurrence has been reported. Prophylactic irradiation in parotid area would be necessary in patients with high risk of parotid lymph node metastasis (PLNM). This study was to detect the high-risk factors of PLNM in nasopharyngeal carcinoma.
This was a 1:2 case-control study. All patients in this study were newly diagnosed NPC with N2-3 classification from January 2005 to December 2012. Cases were 22 sides with ipsilateral PLNM. Controls were 44 patients who were randomly selected from N2-3 disease in database.
20/1096 (1.82 %) NPC patients were found PLNM. Sum of the longest diameter for multiple lymph nodes (SLD) in level II was larger in case group than that in control group (6.0 cm vs. 3.6 cm, p = 0.003). Level II lymph node necrosis, level Va/b involvement, and rare neck areas involvement were more common in case group (p = 0.016, p = 0.034, and p < 0.001, respectively). RPN, level III, and level IV metastases showed no significant difference between the two groups. Multivariate analysis in logistic regression showed that only SLD ≥5 cm in II area (OR = 4.11, p = 0.030) and rare neck areas involvement (OR = 3.95, p = 0.045) were associated with PLNM in NPC patients.
PLNM was an uncommon event in NPC patients. SLD ≥5 cm in level II and involvement in rare-neck areas may be potentially high-risk factors for PLNM. Sparing parotid in IMRT was not recommended for NPC patients with high risks of PLNM.
尽管保留腮腺的调强放射治疗（IMRT）降低了腮腺的剂量分布，但仍有腮腺区域复发的报道。对于有腮腺淋巴结转移（PLNM）高风险的患者，腮腺区域的预防性照射是必要的。本研究旨在检测鼻咽癌中PLNM的高危因素。
这是一项1:2病例对照研究。本研究中的所有患者均为2005年1月至2012年12月新诊断的N2-3期鼻咽癌患者。病例组为22侧同侧PLNM。对照组为从数据库中N2-3期疾病患者中随机选取的44例患者。
1096例鼻咽癌患者中发现20例（1.82%）有PLNM。病例组II区多个淋巴结最长径之和（SLD）大于对照组（6.0 cm对3.6 cm，p = 0.003）。病例组II区淋巴结坏死、Va/b区受累和少见颈部区域受累更为常见（分别为p = 0.016、p = 0.034和p < 0.001）。RPN、III区和IV区转移在两组之间无显著差异。逻辑回归多因素分析显示，仅II区SLD≥5 cm（OR = 4.11，p = 0.030）和少见颈部区域受累（OR = 3.95，p = 0.045）与鼻咽癌患者的PLNM相关。
PLNM在鼻咽癌患者中是不常见的事件。II区SLD≥5 cm和少见颈部区域受累可能是PLNM的潜在高危因素。对于有PLNM高风险的鼻咽癌患者，不建议在IMRT中保留腮腺。
