Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer, Medicine No. 651 Dongfeng Road East, Guangzhou 510060, China.
Department of Molecular Diagnosis, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer, Medicine No. 651 Dongfeng Road East, Guangzhou 510060, China.
Oral Oncol. 2019 Aug;95:150-156. doi: 10.1016/j.oraloncology.2019.06.013. Epub 2019 Jun 22.
In nasopharyngeal carcinoma (NPC), the staging category of parotid lymph node (PLN) metastasis is not explicitly defined, resulting in varied classifications and treatment strategies in clinical practice. This study aimed to determine the prognostic value and optimal staging category of PLN metastasis in NPC.
With the NPC database from a big-data platform, 10,126 patients with primarily diagnosed, non-metastatic NPC and treated with intensity modulated radiotherapy at our center from 2009 to 2015 were analyzed in this study.
In total, 43/10126 patients (0.4%) were diagnosed with histologically verified PLN metastasis at initial diagnosis. Of these, 88.4% (38/43) had enlarged lymph nodes in level II and 34.9% (15/43) in level Ib. Compared with patients without PLN metastasis, those with PLN metastasis had higher risk of disease failure (adjusted hazard ratio [HR], 1.770), distant metastasis (HR, 1.907), and regional recurrence (HR, 3.649), with similar 3-year disease-free survival (70.0% vs. 71.1%) and distant metastasis-free survival (74.8% vs. 77.4%) with patients with N3 disease. Of note, 10/43 patients had regional recurrence: six had recurrent lymph nodes in level Ib; and four of these six patients had no identifiable level Ib lymph nodes on pretreatment imaging.
PLN metastasis was associated with high risk of distant metastasis and regional recurrence, and patients with PLN metastasis had similar outcome compared with patients with N3 disease. Regional recurrences in rare levels, such as level Ib, were common in patients with PLN metastasis at initial diagnosis.
在鼻咽癌（NPC）中，腮腺淋巴结（PLN）转移的分期类别没有明确界定，导致临床实践中存在多种分类和治疗策略。本研究旨在确定 PLN 转移在 NPC 中的预后价值和最佳分期类别。
利用大数据平台的 NPC 数据库，对 2009 年至 2015 年在我中心接受调强放疗治疗的初诊、无远处转移 NPC 患者 10126 例进行了分析。
共有 43/10126（0.4%）例患者在初始诊断时被确诊为组织学证实的 PLN 转移。其中，88.4%（38/43）的患者 II 区有肿大的淋巴结，34.9%（15/43）的患者 Ib 区有肿大的淋巴结。与无 PLN 转移的患者相比，PLN 转移的患者疾病失败的风险更高（调整后的危险比[HR]，1.770），远处转移的风险更高（HR，1.907），区域复发的风险更高（HR，3.649），但 3 年无病生存率（70.0%比 71.1%）和无远处转移生存率（74.8%比 77.4%）相似。值得注意的是，有 10/43 例患者出现区域复发：6 例患者 Ib 区有复发性淋巴结；其中 6 例中有 4 例患者在预处理影像学上无法识别 Ib 区淋巴结。
PLN 转移与远处转移和区域复发的高风险相关，且与 N3 疾病患者相比，PLN 转移患者的结局相似。在初诊时就有 PLN 转移的患者中，Ib 区等罕见部位的区域复发较为常见。
