Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Ann Med. 2022 Dec;54(1):436-441. doi: 10.1080/07853890.2022.2031270.
Supporting data defining the selection criteria of level VIIb for inclusion in the target volume in radiotherapy (RT) planning are insufficient. We evaluated the prevalence of level VIIb retro-styloid lymph node metastasis (RSLNM) and associated risk factors in patients with oropharyngeal carcinoma (OPC).
We retrospectively reviewed pre-treatment [F]-fluoro-2-deoxy-d-glucose-positron emission tomography/computed tomography (CT) along with contrast-enhanced thin slice CT and magnetic resonance (MR) images of 137 patients pathologically confirmed as having OPC who underwent RT. The location of lymph nodes (LNs) was confirmed on the planning CT images. Fisher's exact test and logistic regression analyses were made to determine the risk factors of RSLNM.
RSLNM was confirmed in 18 (13%) patients. All RSLNMs were located within level VIIb on the planning CT images. No patients exhibited LNM in contralateral level VIIb. Furthermore, no patients with negative or single ipsilateral cervical LNM had RSLNM. Fisher's exact test revealed that smoking status (=.027), multiple ipsilateral cervical LNM (=.045) and LN ≥15 mm in the upper limit of ipsilateral level II (<.001) were significantly associated with RSLNM. Logistic regression analyses revealed that the presence of LNs ≥15 mm in upper limit of ipsilateral level II was significantly associated with RSLNM (odds ratio: 977.297; 95% confidence interval: 57.629-16573.308; <.001).
RSLNM is relatively common in patients with OPC with a prevalence rate of approximately 10%. The prevalence of RSLNM in patients with negative or single ipsilateral cervical LNM and contralateral RSLNM is extremely low; therefore, level VIIb can be excluded from the target volume in such patients. LN ≥15 mm in the upper limit of ipsilateral level II is a risk factor for RSLNM. Ipsilateral level VIIb should be included in the target volume for patients with this risk factor.KEY MESSAGERetro-styloid lymph node metastasis (RSLNM) prevalence is ∼10% in oropharyngeal carcinoma.Lymph node ≥15 mm in ipsilateral level II upper limit is a risk factor for RSLNM.
支持将 VIIb 水平纳入放射治疗 (RT) 计划靶区选择标准的支持数据不足。我们评估了头颈部鳞癌 (HNSCC) 患者中 VIIb 颈后淋巴结转移 (RSLNM) 的发生率和相关危险因素。
我们回顾性分析了 137 例经病理证实的 HNSCC 患者的治疗前 [F]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描 (PET/CT) 以及对比增强薄层 CT 和磁共振 (MR) 图像。在计划 CT 图像上确定淋巴结 (LNs) 的位置。采用 Fisher 确切检验和 logistic 回归分析确定 RSLNM 的危险因素。
18 例 (13%)患者证实存在 RSLNM。所有 RSLNMs 在计划 CT 图像上均位于 VIIb 水平。无患者对侧 VIIb 水平出现 LNM。此外，无同侧颈淋巴结阴性或单个颈淋巴结转移的患者出现 RSLNM。Fisher 确切检验显示，吸烟状态（=.027）、同侧颈多个淋巴结转移（=.045）和同侧 II 区上界 LN 直径≥15mm（<.001）与 RSLNM 显著相关。Logistic 回归分析显示，同侧 II 区上界 LN 直径≥15mm 与 RSLNM 显著相关（优势比：977.297；95%置信区间：57.629-16573.308；<.001）。
RSLNM 在 HNSCC 患者中较为常见，发生率约为 10%。同侧颈淋巴结阴性或单个颈淋巴结转移和对侧 RSLNM 患者 RSLNM 发生率极低；因此，对于此类患者，可以将 VIIb 水平排除在靶区之外。同侧 II 区上界 LN 直径≥15mm 是 RSLNM 的危险因素。对于有此危险因素的患者，同侧 VIIb 水平应纳入靶区。
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