Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.
Department of Radiation Oncology, Cancer Center, First People's Hospital of Foshan Affiliated to Sun Yat-sen University, China; Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China; Department of Radiation Oncology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Radiother Oncol. 2020 Oct;151:40-46. doi: 10.1016/j.radonc.2020.07.023. Epub 2020 Jul 15.
The number of metastatic lymph nodes (LNs) has been demonstrated to be an important prognosticator in some head and neck cancers. This study aimed to examine its prognostic value in nasopharyngeal carcinoma (NPC).
Patients with newly-diagnosed, non-distant metastatic NPC from two centers were enrolled in this study. According to the radiologic criteria for involved LNs, the number of positive LNs was assessed on MRI. Univariate and multivariate models were constructed to assess the association between the number of positive LNs and clinical outcomes. Exhaustive method was used to determine the cutoff values of the number of positive LNs.
In 1224 patients, the number of MRI-positive LNs was an independent risk factor for overall survival (OS), distant metastasis-free survival (DMFS), relapse-free survival (RFS), progression-free survival (PFS) and regional relapse-free survival (RRFS), surpassing other nodal factors. All the patients were divided into no, low (1-4 positive LNs), moderate (5-9 positive LNs) and high (>9 positive LNs) risk groups. The HRs of high-risk group exceeded the HRs of N3 classification for OS, DMFS, RFS, PFS and RRFS. On upgrading patients with more than 9 positive LNs from N2 to N3, the revised N-staging system showed a higher C-index compared to current N-staging system for predicting OS (0.747 vs. 0.741, P = 0.002), RFS (0.655 vs. 0.640, P = 0.015) and PFS (0.674 vs. 0.669, P = 0.035).
The number of MRI-positive LNs was a predominant independent prognostic factor for NPC patients' survival. It may be incorporated into the future N-staging system to improve its accuracy in predicting outcomes.
在一些头颈部癌症中，转移淋巴结（LNs）的数量已被证明是一个重要的预后因素。本研究旨在探讨其在鼻咽癌（NPC）中的预后价值。
本研究纳入了来自两个中心的新诊断、无远处转移的 NPC 患者。根据 MRI 评估 LN 转移的影像学标准，评估 MRI 阳性 LNs 的数量。构建单因素和多因素模型来评估阳性 LNs 数量与临床结局之间的关联。采用穷尽法确定阳性 LNs 数量的截断值。
在 1224 例患者中，MRI 阳性 LNs 的数量是总生存（OS）、远处无转移生存（DMFS）、无复发生存（RFS）、无进展生存（PFS）和区域无复发生存（RRFS）的独立危险因素，超过了其他淋巴结因素。所有患者被分为无、低危（1-4 个阳性 LNs）、中危（5-9 个阳性 LNs）和高危（>9 个阳性 LNs）组。高危组的 HR 超过了 N3 分类对 OS、DMFS、RFS、PFS 和 RRFS 的 HR。将 MRI 阳性 LNs 数量大于 9 个的患者从 N2 升级为 N3，修订后的 N 分期系统在预测 OS（0.747 比 0.741，P=0.002）、RFS（0.655 比 0.640，P=0.015）和 PFS（0.674 比 0.669，P=0.035）方面的准确性高于现行的 N 分期系统。
MRI 阳性 LNs 的数量是 NPC 患者生存的主要独立预后因素。它可能被纳入未来的 N 分期系统，以提高其预测结局的准确性。
