鼻咽癌颈部淋巴结坏死的预后价值及治疗选择的潜在作用

Prognostic value and the potential role of treatment options for cervical lymph node necrosis in nasopharyngeal carcinoma.

作者信息

Liu Kuiyuan, Lin Siting, Ke Liangru, Xia Weixiong, Zhang Chun, Li Jianpeng, Gao Mingyong, Qiang Mengyun, Chen Xi, Liu Jia, Xie Chuanmiao, Guo Xiang, Lv Xing

机构信息

State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, Guangdong 510060, People's Republic of China.

State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China.

出版信息

Oral Oncol. 2020 Jun 27;109:104864. doi: 10.1016/j.oraloncology.2020.104864.

DOI:10.1016/j.oraloncology.2020.104864

PMID:32604061

Abstract

OBJECTIVE

There were few studies focused on the cervical lymph necrosis (CNN) of nasopharyngeal carcinoma (NPC) patients to develop a nomogram and guide the treatment decision at the era of intensity modulated radiation therapy (IMRT).

MATERIAL AND METHODS

The prognostic accuracy of CNN in the training cohort (n = 1940) was validated in Guangzhou internal validation cohort (n = 832) and two external validation cohorts (Dongguan, n = 232; Foshan, n = 134).

RESULTS

The primary end point was progression-free survival (PFS), calculated using the Kaplan-Meier method. After a median 60.0 months' follow-up, patients with CNN in the training cohort had worse 5-year PFS (70.8% vs. 89.1%, P < 0.001) than patients without CNN, which was validated in the validation cohorts. The nomogram based on CNN predicted an individual PFS risk (training: C-index 0.733; Guangzhou validation: C-index 0.736; Foshan: C-index 0.722; Dongguan: C-index 0.756). Stage N2 patients in the CNN group and stage IV patients no matter the status of CNN, PFS was better with induction chemotherapy (ICT) and CCRT than CCRT (P < 0.05).

CONCLUSION

Taken together, CNN reliably predicts survival risk in NPC patients. N2 patients in the CNN group and stage IV patients may receive survival benefit from ICT.

摘要

目的

在调强放射治疗（IMRT）时代，针对鼻咽癌（NPC）患者颈部淋巴结坏死（CNN）开展列线图并指导治疗决策的研究较少。

材料与方法

在广州内部验证队列（n = 832）和两个外部验证队列（东莞，n = 232；佛山，n = 134）中验证训练队列（n = 1940）中CNN的预后准确性。

结果

主要终点为无进展生存期（PFS），采用Kaplan-Meier法计算。经过中位60.0个月的随访，训练队列中发生CNN的患者5年PFS较未发生CNN的患者更差（70.8%对89.1%，P < 0.001），这在验证队列中得到了验证。基于CNN的列线图预测个体PFS风险（训练：C指数0.733；广州验证：C指数0.736；佛山：C指数0.722；东莞：C指数0.756）。CNN组的N2期患者和无论CNN状态如何的IV期患者，诱导化疗（ICT）联合同期放化疗（CCRT）的PFS优于单纯CCRT（P < 0.05）。