鼻咽癌患者小淋巴结转移的发生率：对预后和治疗的临床意义

Incidence of small lymph node metastases in patients with nasopharyngeal carcinoma: Clinical implications for prognosis and treatment.

作者信息

Xu Peng, Min Yanmei, Blanchard Pierre, Feng Mei, Zhang Peng, Luo Yangkun, Fan Zixuan, Lang Jinyi

机构信息

Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu, China.

Department of Radiation Oncology, The Third Hospital of Mianyang, Mianyang, China.

出版信息

Head Neck. 2017 Feb;39(2):305-310. doi: 10.1002/hed.24586. Epub 2016 Sep 14.

DOI:10.1002/hed.24586

PMID:27627795

Abstract

BACKGROUND

Patients with nasopharyngeal carcinoma (NPC) often present small lymph nodes. The purpose of this study was to determine the prognostic impact on local recurrence of small lymph nodes, defined as smaller than 10 mm in greatest diameter.

METHODS

Consecutive patients treated by intensity-modulated radiotherapy (IMRT) for pathologically confirmed NPC were analyzed retrospectively. Those without small lymph nodes were excluded from the study. From January 2005 to January 2011, 275 patients with NPC represented with 2722 small lymph nodes, which were analyzed. Small lymph node axial diameter was measured using CT/MRI before radiotherapy (RT), at 50 Gy, and 6 months after the end of RT. The dose received by the small lymph nodes and the changes in lymph node diameter were recorded. Clinical endpoints were overall survival (OS), locoregional control, disease-specific survival (DSS), and distant metastasis-free survival. Median follow-up time was 55 months (range, 5-96 months).

RESULTS

Patients were grouped according to the dose received by the small lymph nodes and the number of small lymph nodes. Only 27 patients (9.8%) had a decrease ≥50% in the small lymph node diameter at 50 Gy and 53 patients (19.3%) had a decrease ≥50% at 6 months after RT. The 5-year locoregional control, distant metastasis-free survival, DSS, and OS were 93.5%, 85.2%, 88.8%, and 87.0%, respectively. Multivariate analyses showed that T classification and N classification are independent prognostic factors for OS. However, the dose received and the numbers of small lymph nodes were not statistically associated with any of the survival endpoints.

CONCLUSION

In the IMRT era, N classification remains an independent prognostic factor in NPC. However, the incidence of small lymph nodes is not a significant prognostic factor in patients with NPC. The presence of small lymph nodes should not influence the nodal contouring or the dose delivered to nodal areas. © 2016 Wiley Periodicals, Inc. Head Neck 39: 305-310, 2017.

摘要

背景

鼻咽癌（NPC）患者常出现小淋巴结。本研究的目的是确定最大直径小于10mm的小淋巴结对局部复发的预后影响。

方法

回顾性分析接受调强放疗（IMRT）治疗的经病理确诊的NPC连续患者。无小淋巴结的患者被排除在研究之外。2005年1月至2011年1月，275例NPC患者共出现2722个小淋巴结，对其进行分析。在放疗（RT）前、50Gy时以及RT结束后6个月，使用CT/MRI测量小淋巴结的轴向直径。记录小淋巴结接受的剂量以及淋巴结直径的变化。临床终点为总生存（OS）、局部区域控制、疾病特异性生存（DSS）和无远处转移生存。中位随访时间为55个月（范围5 - 96个月）。

结果

根据小淋巴结接受的剂量和小淋巴结数量对患者进行分组。仅27例患者（9.8%）在50Gy时小淋巴结直径减小≥50%，53例患者（19.3%）在RT结束后6个月时小淋巴结直径减小≥50%。5年局部区域控制率、无远处转移生存率、DSS和OS分别为93.5%、85.2%、88.8%和87.0%。多因素分析显示，T分期和N分期是OS的独立预后因素。然而，接受的剂量和小淋巴结数量与任何生存终点均无统计学关联。