Lu L, Wei X, Li Y H, Li W B
Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing.
Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, and.
Curr Oncol. 2017 Jun;24(3):e220-e225. doi: 10.3747/co.24.3168. Epub 2017 Jun 27.
We explored the patterns of sentinel node metastasis and investigated the prognostic value of sentinel node necrosis (snn) in patients with nasopharyngeal carcinoma (npc), based on magnetic resonance imaging (mri).
This retrospective study enrolled 252 patients at our institution who had metastatic lymph nodes from biopsy-confirmed npc and who were treated with definitive radiation therapy, with or without chemotherapy. All participants underwent mri before treatment, and the resulting images were reviewed to evaluate lymph node status. The patients were divided into snn and non-snn groups. Overall survival (os), tumour-free survival (tfs), regional relapse-free survival (rrfs), and distant metastasis-free survival (dmfs) were calculated by the Kaplan-Meier method, and differences were compared using the log-rank test. Factors predictive of outcome were determined by univariate and multivariate analysis.
Of the 252 patients, 189 (75%) had retropharyngeal lymph node metastasis, and 189 (75%) had level iia or iib lymph node necrosis. The incidence of snn was 43.4% (91 of 210 patients with lymph node metastasis or necrosis, or both). After a median follow-up of 54 months, the 5-year rates of os, tfs, rrfs, and dmfs in the snn and non-snn groups were, respectively, 79.4% and 95.3%, 73.5% and 93.3%, 80.4% and 96.6%, and 75.5% and 95.3% (all < 0.01). Age greater than 40 years, snn, T stage, and N stage were significant independent negative prognostic factors for os, tfs, rrfs, and dmfs.
Metastatic retropharyngeal lymph nodes and necrotic level ii nodes both seem to act as sentinels. Sentinel node necrosis is an negative prognostic factor in patients with npc. Patients with snn have a worse prognosis.
基于磁共振成像（MRI），我们探讨了鼻咽癌（NPC）患者前哨淋巴结转移模式，并研究了前哨淋巴结坏死（snn）的预后价值。
这项回顾性研究纳入了我院252例经活检确诊为NPC且有转移性淋巴结的患者，这些患者接受了确定性放射治疗，部分患者还接受了化疗。所有参与者在治疗前均接受了MRI检查，并对所得图像进行评估以确定淋巴结状态。患者被分为snn组和非snn组。采用Kaplan-Meier法计算总生存期（OS）、无瘤生存期（TFS）、区域无复发生存期（RRFS）和远处无转移生存期（DMFS），并使用对数秩检验比较差异。通过单因素和多因素分析确定预后的预测因素。
252例患者中，189例（75%）有咽后淋巴结转移，189例（75%）有Ⅱa或Ⅱb级淋巴结坏死。snn的发生率为43.4%（210例有淋巴结转移或坏死或两者皆有的患者中91例）。中位随访54个月后，snn组和非snn组的5年OS率、TFS率、RRFS率和DMFS率分别为79.4%和95.3%、73.5%和93.3%、80.4%和96.6%、75.5%和95.3%（均P<0.01）。年龄大于40岁、snn、T分期和N分期是OS、TFS、RRFS和DMFS的显著独立负性预后因素。
转移性咽后淋巴结和坏死的Ⅱ级淋巴结似乎都起到了前哨作用。前哨淋巴结坏死是NPC患者的负性预后因素。snn患者预后较差。
