基于磁共振成像的转移淋巴结数量及相关列线图改善鼻咽癌患者分层：个体化诱导化疗的潜在指征
MRI-Based Metastatic Nodal Number and Associated Nomogram Improve Stratification of Nasopharyngeal Carcinoma Patients: Potential Indications for Individual Induction Chemotherapy.
作者信息
Zhao Qin, Dong Annan, Cui Chunyan, Ou Qiaowen, Ruan Guangying, Zhou Jian, Tian Li, Liu Lizhi, Ma Huali, Li Haojiang
机构信息
Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China.
Department of Clinical Nutrition, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, People's Republic of China.
出版信息
J Magn Reson Imaging. 2023 Jun;57(6):1790-1802. doi: 10.1002/jmri.28435. Epub 2022 Sep 28.
BACKGROUND
Metastatic lymph nodal number (LNN) is associated with the survival of nasopharyngeal carcinoma (NPC); however, counting multiple nodes is cumbersome.
PURPOSE
To explore LNN threshold and evaluate its use in risk stratification and induction chemotherapy (IC) indication.
STUDY TYPE
Retrospective.
POPULATION
A total of 792 radiotherapy-treated NPC patients (N classification: N0 182, N1 438, N2 113, N3 59; training group: 396, validation group: 396; receiving IC: 390).
FIELD STRENGTH/SEQUENCE: T1-, T2- and postcontrast T1-weighted fast spin echo MRI at 1.5 or 3.0 T.
ASSESSMENT
Nomogram with (model B) or without (model A) LNN was constructed to evaluate the 5-year overall (OS), distant metastasis-free (DMFS), and progression-free survival (PFS) for the group as a whole and N1 stage subgroup. High- and low-risk groups were divided (above vs below LNN- or model B-threshold); their response to IC was evaluated among advanced patients in stage III/IV.
STATISTICAL TESTS
Maximally selected rank, univariate and multivariable Cox analysis identified the optimal LNN threshold and other variables. Harrell's concordance index (C-index) and 2-fold cross-validation evaluated discriminative ability of models. Matched-pair analysis compared survival outcomes of adding IC or not. A P value < 0.05 was considered statistically significant.
RESULTS
Median follow-up duration was 62.1 months. LNN ≥ 4 was independently associated with decreased 5-year DMFS, OS, and PFS in entire patients or N1 subgroup. Compared to model A, model B (adding LNN, LNN ≥ 4 vs <4) presented superior C-indexes in the training (0.755 vs 0.727) and validation groups (0.676 vs 0.642) for discriminating DMFS. High-risk patients benefited from IC with improved post-IC response and OS, but low-risk patients did not (P = 0.785 and 0.690, respectively).
CONCLUSIONS
LNN ≥ 4 is an independent risk stratification factor of worse survival in entire or N1 staging NPC patients. LNN ≥ 4 or the associated nomogram has potential to identify high-risk patients requiring IC.
EVIDENCE LEVEL
4 TECHNICAL EFFICACY: 4.
背景
转移性淋巴结数目（LNN）与鼻咽癌（NPC）患者的生存相关；然而，对多个淋巴结进行计数很繁琐。
目的
探索LNN阈值并评估其在风险分层和诱导化疗（IC）指征中的应用。
研究类型
回顾性研究。
研究对象
共792例接受放疗的NPC患者（N分期：N0 182例，N1 438例，N2 113例，N3 59例；训练组：396例，验证组：396例；接受IC治疗：390例）。
场强/序列：1.5或3.0 T的T1加权、T2加权及增强后T1加权快速自旋回波MRI。
评估
构建包含（模型B）或不包含（模型A）LNN的列线图，以评估整个研究组及N1期亚组的5年总生存率（OS）、无远处转移生存率（DMFS）和无进展生存率（PFS）。划分高危和低危组（LNN或模型B阈值以上与以下）；在III/IV期晚期患者中评估其对IC的反应。
统计检验
最大选择秩、单因素和多因素Cox分析确定最佳LNN阈值及其他变量。Harrell一致性指数（C指数）和2倍交叉验证评估模型的判别能力。配对分析比较加用IC与否的生存结果。P值<0.05被认为具有统计学意义。
结果
中位随访时间为62.1个月。LNN≥4与整个患者或N1亚组5年DMFS、OS和PFS降低独立相关。与模型A相比，模型B（加入LNN，LNN≥4与<4）在训练组（0.755对0.727）和验证组（0.676对0.642）中用于判别DMFS时具有更高的C指数。高危患者从IC中获益，IC后反应和OS得到改善，但低危患者未获益（P分别为0.785和0.690）。
结论
LNN≥4是整个或N1分期NPC患者生存较差的独立风险分层因素。LNN≥4或相关列线图有潜力识别需要IC治疗的高危患者。
证据水平
4 技术疗效：4。
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