Zhang Lu-Lu, Li Jia-Xiang, Zhou Guan-Qun, Tang Ling-Long, Ma Jun, Lin Ai-Hua, Qi Zhen-Yu, Sun Ying
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China.
Department of Oncology, First People's Hospital of Zhaoqing City, Guangdong, People's Republic of China.
J Cancer. 2017 Mar 12;8(6):959-966. doi: 10.7150/jca.17998. eCollection 2017.
To analyze the prognostic value of cervical node necrosis (CNN) observed on pretreatment magnetic resonance imaging (MRI) in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT). The medical records of 1423 NPC patients with cervical node metastasis who underwent IMRT were retrospectively reviewed. Lymph nodes in the axial plane of pretreatment MRI were classified as follows: grade 0 CNN, no hypodense zones; grade 1 CNN, ≤33% areas showing hypodense zones; and grade 2, >33% areas showing hypodense zones. CNN was detectable in 470/1423 (33%) patients. Of these 470 patients, 213 (15%) and 257 (18%) exhibited grade 1 and grade 2 CNN. The grade 0 and grade 1 CNN groups showed significant differences with regard to distant metastasis-free survival (DMFS), but not overall survival (OS), regional relapse-free survival (RRFS), local relapse-free survival (LRFS), and disease-free survival (DFS). Significant differences were observed among the grade 0 and grade 2 CNN groups with regard to OS, RRFS, LRFS, DMFS, and DFS. Moreover, OS, LRFS, RRFS, and DFS were significantly different between the grade 1 and grade 2 CNN groups, whereas DMFS showed no significant differences. Univariate and multivariate analyses revealed CNN on MRI as a significant negative prognostic factor for OS, LRFS, RRFS, DMFS, and DFS in NPC patients. NPC patients with CNN of different grades show various prognosis and failure patterns after IMRT. CNN on MRI can be adopted as a predictive factor for formulating individualized treatment plans for NPC patients.
分析在接受调强放疗（IMRT）的鼻咽癌（NPC）患者中，治疗前磁共振成像（MRI）观察到的颈部淋巴结坏死（CNN）的预后价值。回顾性分析1423例接受IMRT治疗且有颈部淋巴结转移的NPC患者的病历。治疗前MRI轴位平面上的淋巴结分类如下：0级CNN，无低密度区；1级CNN，低密度区面积≤33%；2级，低密度区面积>33%。1423例患者中有470例（33%）可检测到CNN。在这470例患者中，213例（15%）和257例（18%）表现为1级和2级CNN。0级和1级CNN组在无远处转移生存期（DMFS）方面有显著差异，但在总生存期（OS）、无区域复发生存期（RRFS）、无局部复发生存期（LRFS）和无病生存期（DFS）方面无显著差异。0级和2级CNN组在OS、RRFS、LRFS、DMFS和DFS方面有显著差异。此外，1级和2级CNN组在OS、LRFS、RRFS和DFS方面有显著差异，而DMFS无显著差异。单因素和多因素分析显示，MRI上的CNN是NPC患者OS、LRFS、RRFS、DMFS和DFS的显著负性预后因素。不同等级CNN的NPC患者在IMRT后表现出不同的预后和失败模式。MRI上的CNN可作为制定NPC患者个体化治疗方案的预测因素。
