新型影像学分类系统可用于 HPV 相关口咽鳞癌的淋巴结疾病分期，预测患者预后。
Novel imaging classification system of nodal disease in human papillomavirus-mediated oropharyngeal squamous cell carcinoma prognostic of patient outcomes.
机构信息
Department of Radiology, Division of Neuroradiology, University of Calgary, Calgary, Alberta, Canada.
Department of Radiation Oncology, University of Calgary, Calgary, Alberta, Canada.
出版信息
Head Neck. 2021 Jun;43(6):1854-1863. doi: 10.1002/hed.26657. Epub 2021 Feb 26.
BACKGROUND
Matted nodes in human papillomavirus (HPV)-mediated oropharyngeal squamous cell carcinoma (OPC) is an independent predictor of distant metastases and decreased overall survival. We aimed to classify imaging patterns of metastatic lymphadenopathy, analyze our classification system for reproducibility, and assess its prognostic value.
METHODS
The metastatic lymphadenopathy was classified based on radiological characteristics for 216 patients with HPV-mediated OPC. Patient outcomes were compared and inter-rater reliability was calculated.
RESULTS
The presence of ≥3 abutting lymph nodes with imaging features of surrounding extranodal extension (ENE), one subtype of matted nodes, was associated with worse 5-year overall survival, overall recurrence-free survival, regional recurrence-free survival, and distant recurrence-free survival (p ≤ 0.03). Other patterns were not significantly associated with outcome measures. Overall inter-rater agreement was substantial (κ = 0.73).
CONCLUSION
One subtype of matted nodes defined by ≥3 abutting lymph nodes with imaging features of surrounding ENE is the radiological marker of worst prognosis.
背景
人乳头瘤病毒（HPV）介导的口咽鳞状细胞癌（OPC）中的融合淋巴结是远处转移和总生存降低的独立预测因子。我们旨在对转移性淋巴结病的影像学模式进行分类，分析我们的分类系统的可重复性，并评估其预后价值。
方法
对 216 例 HPV 介导的 OPC 患者的转移性淋巴结病进行基于影像学特征的分类。比较患者的结局并计算组内可靠性。
结果
存在≥3 个具有周围结外延伸（ENE）影像学特征的融合淋巴结（matted nodes 的一个亚型）与较差的 5 年总生存率、总无复发生存率、区域无复发生存率和远处无复发生存率相关（p≤0.03）。其他模式与预后指标无显著相关性。总体组内可靠性较高（κ=0.73）。
结论
≥3 个具有周围 ENE 影像学特征的融合淋巴结定义的 matted nodes 的一个亚型是预后最差的影像学标志物。
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