Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China.
Cancer Res Treat. 2019 Jul;51(3):1222-1230. doi: 10.4143/crt.2018.595. Epub 2018 Dec 27.
The aim of the present study was to evaluate the prognostic value of magnetic resonance imaging (MRI)‒determined lymph nodal necrosis (LNN) in nasopharyngeal carcinoma (NPC) and explore the feasibility of an N-classification system based on the 8th edition of the American Joint Committee on Cancer (AJCC) system.
The MRI scans of 616 patients with newly diagnosed stage T1-4N1-3M0 NPC who were treated with definitive intensity-modulated radiotherapy (IMRT) were reviewed.
Multivariate analysis showed that LNN was an independent negative prognostic predictor of distant metastasis free survival (hazard ratio, 1.634; 95% confidence interval, 1.023 to 2.609; p=0.040) and overall survival (hazard ratio, 2.154; 95% confidence interval, 1.282 to 3.620; p=0.004). Patients of classification N1 disease with LNN were reclassified as classification N2, and classification N2 disease with LNN as classification N3 in the proposed N-classification system. Correlation with death and distant failure was significant, and the total difference between N1 and N3 was wider with the proposed system.
MRI-determined LNN is an independent negative prognostic factor for NPC. The proposed N classification system is powerfully predictive.
本研究旨在评估磁共振成像（MRI）确定的淋巴结坏死（LNN）在鼻咽癌（NPC）中的预后价值，并探讨基于第 8 版美国癌症联合委员会（AJCC）系统的 N 分类系统的可行性。
回顾了 616 例接受根治性调强放疗（IMRT）治疗的初诊 T1-4N1-3M0 NPC 患者的 MRI 扫描。
多因素分析显示，LNN 是远处无转移生存（风险比，1.634；95%置信区间，1.023 至 2.609；p=0.040）和总生存（风险比，2.154；95%置信区间，1.282 至 3.620；p=0.004）的独立负预后预测因子。在提出的 N 分类系统中，N1 疾病伴有 LNN 的患者被重新分类为 N2，N2 疾病伴有 LNN 的患者被重新分类为 N3。与死亡和远处失败的相关性显著，且与新系统相比，N1 和 N3 之间的总差异更大。
MRI 确定的 LNN 是 NPC 的独立负预后因素。提出的 N 分类系统具有较强的预测能力。
