在加拿大队列中治疗的鼻咽癌中放射学结外扩展的预后意义。
Prognostic importance of radiologic extranodal extension in nasopharyngeal carcinoma treated in a Canadian cohort.
机构信息
Department of Neuroradiology, University of Toronto, Canada.
Department of Neuroradiology, University of Toronto, Canada; Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University of Toronto, Canada.
出版信息
Radiother Oncol. 2021 Dec;165:94-102. doi: 10.1016/j.radonc.2021.10.018. Epub 2021 Oct 27.
PURPOSE
To confirm the prognostic value of radiologic extranodal extension (rENE) and its role in clinical-N classification in nasopharyngeal carcinoma (NPC) treated in a western institution.
METHODS AND MATERIALS
NPC treated between 2010 and 2017 were included. Pre-treatment MRI were reviewed for unequivocal rENE and its grade: grade-1: tumour invading through any nodal capsule but confined to perinodal fat; grade-2: ≥2 adjacent nodes forming a coalescent nodal mass; grade-3: tumour extending beyond perinodal fat to invade/encase adjacent structures. Overall survival (OS) and disease-free survival (DFS) were compared between rENE-positive (rENE+) and rENE-negative (rENE-) patients. Multivariable analysis (MVA) confirmed the prognostic importance of rENE and its grade. Staging schemas including rENE in N-classification were proposed and their performance evaluated.
RESULTS
A total of 274 patients were eligible (43 cN0; 231 cN-positive). rENE was identified in 83/231 (36%) cN-positive, including grade 1/2/3 rENE in 14/58/11 cases. Compared to rENE-, rENE+ patients had a lower OS (68% vs 89%, p < 0.001) and DFS (58% vs 80%, p < 0.001). MVA confirmed the prognostic importance of grade-2 [HR: OS: 2.85 (p = 0.005); DFS: 2.89 (p < 0.001)] and grade-3 rENE [HR: OS 5.28 (p = 0.004); DFS 3.86 (p = 0.005)], with a trend for grade-1 vs rENE- [HR: OS 2.63 (p = 0.13); DFS 1.49 (p = 0.520)]. We evaluated classifying any rENE as cN3 (Proposal-I) or any grade-2/grade-3 rENE as cN3 (Proposal-II). The stage schema with Proposal-I cN-classification ranked the highest in the performance evaluation.
CONCLUSIONS
rENE is an important prognostic factor in this western NPC cohort. We propose classifying any unequivocal rENE as cN3.
目的
在西方医疗机构治疗的鼻咽癌（NPC）中，确认放射学结外侵犯（rENE）的预后价值及其在临床 N 分类中的作用。
方法和材料
纳入 2010 年至 2017 年间治疗的 NPC 患者。对治疗前 MRI 进行评估，以明确 rENE 及其分级：1 级：肿瘤穿过任何淋巴结包膜，但局限于包膜内脂肪；2 级：≥2 个相邻淋巴结形成融合性淋巴结团块；3 级：肿瘤侵犯包膜外脂肪，侵犯/包裹相邻结构。比较 rENE 阳性（rENE+）和 rENE 阴性（rENE-）患者的总生存（OS）和无病生存（DFS）。多变量分析（MVA）确认了 rENE 及其分级的预后重要性。提出了包括 rENE 在 N 分类中的分期方案，并评估了其性能。
结果
共有 274 名患者符合条件（43 例 cN0；231 例 cN+）。在 231 例 cN+中，有 83 例（36%）存在 rENE，其中 14 例、58 例和 11 例分别为 1 级/2 级/3 级 rENE。与 rENE-相比，rENE+患者的 OS（68% vs 89%，p<0.001）和 DFS（58% vs 80%，p<0.001）较低。MVA 证实了 2 级 rENE [HR：OS：2.85（p=0.005）；DFS：2.89（p<0.001）]和 3 级 rENE [HR：OS 5.28（p=0.004）；DFS 3.86（p=0.005）]的预后重要性，1 级 rENE 也有趋势[HR：OS 2.63（p=0.13）；DFS 1.49（p=0.520）]。我们评估了将任何 rENE 分类为 cN3（方案 I）或任何 2 级/3 级 rENE 分类为 cN3（方案 II）。在性能评估中，方案 I 的 cN 分类表现最佳。
结论
rENE 是西方 NPC 队列中一个重要的预后因素。我们建议将任何明确的 rENE 分类为 cN3。
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