将放疗后 MRI 检测到的淋巴结坏死与治疗前后 EBV-DNA 整合，用于鼻咽癌的风险分层。

Integrating Postradiotherapy MRI-Detected Lymph Node Necrosis and Pre- and Posttreatment Epstein-Barr Virus-DNA for Risk Stratification in Nasopharyngeal Carcinoma.

机构信息

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, People's Republic of China.

Department of Radiology, The Third People's Hospital of Shenzhen, Shenzhen, People's Republic of China.

出版信息

J Magn Reson Imaging. 2023 Jul;58(1):108-119. doi: 10.1002/jmri.28515. Epub 2022 Nov 3.

DOI:10.1002/jmri.28515

PMID:36326089

Abstract

BACKGROUND

Residual lymphadenopathy and detectable Epstein-Barr virus (EBV) DNA after radiotherapy (RT) are known negative prognostic factors for nasopharyngeal carcinoma (NPC). However, there is a need to distinguish between patients with residual disease that will metastasize and those who will not.

PURPOSE

To develop a prognostic model to improve the risk stratification of NPC patients after RT.

STUDY TYPE

Retrospective.

POPULATION

Three hundred eighty-seven NPC patients treated with RT between January 2010 and January 2013.

FIELD STRENGTH/SEQUENCE: T1-, T2-weighted and enhanced T1-weighted imaging at 1.5 or 3.0 T pretreatment and 3-4 months post-RT.

ASSESSMENT

Post-RT central nodal necrosis (CNN) and other nodal characteristics on MRI were assessed by three radiologists independently. EBV DNA was measured by quantitative polymerase chain reaction. The association between these variables and the primary endpoint (5-year distant metastasis-free survival [DMFS], time from the day of diagnosis to any distant metastasis) was analyzed. Nomograms A (pre-/posttreatment EBV-DNA + N stage + post-RT retropharyngeal lymph node [RLN] CNN), B (tumor-node-metastasis [TNM] stage + pretreatment EBV-DNA), and C (TNM stage + post-RT EBV-DNA) were developed.

STATISTICAL TESTS

Univariate and multivariate analyses were performed with the Cox regression model. Nomograms were developed based on the Cox regression model and two prognostic models. The concordance index (C-index) and calibration curve were used to evaluate the discriminative ability of the nomograms and TNM stage. P-values < 0.05 were considered statistically significant.

RESULTS

Post-RT RLN CNN was an independent prognostic factor for 5-year DMFS (hazard ratio, 2.88 [1.48-5.62]). Nomogram A (C-index 0.728 [0.660-0.797]) demonstrated better risk discrimination than nomogram B (0.638 [0.571-0.705]), nomogram C (0.707 [0.636-0.778]), and the TNM stage (0.587 [0.515-0.659]) for 5-year DMFS in NPC.

DATA CONCLUSION

Nomogram A combining pretreatment EBV-DNA and N stage with post-RT EBV-DNA and RLN CNN improved the prognostic risk stratification for DMFS in NPC.

EVIDENCE LEVEL

4 TECHNICAL EFFICACY: Stage 2.

摘要

背景

放疗后残留淋巴结肿大和可检测到的 Epstein-Barr 病毒 (EBV) DNA 是鼻咽癌 (NPC) 的已知不良预后因素。然而，需要区分哪些是会转移的残留疾病患者，哪些不会转移。

目的

建立一个 NPC 患者放疗后预后模型，以改善风险分层。

研究类型

回顾性。

人群

387 名 NPC 患者，2010 年 1 月至 2013 年 1 月接受放疗。

磁场强度/序列：1.5 或 3.0T 治疗前和放疗后 3-4 个月行 T1-、T2 加权和增强 T1 加权成像。

评估

由 3 名放射科医生独立评估 MRI 上的放疗后中央淋巴结坏死（CNN）和其他淋巴结特征。采用实时聚合酶链反应（PCR）定量检测 EBV DNA。分析这些变量与主要终点（5 年无远处转移生存（DMFS），从诊断之日到任何远处转移的时间）之间的关系。建立了列线图 A（治疗前/后 EBV-DNA+N 期+放疗后咽后淋巴结 [RLN] CNN）、B（肿瘤-淋巴结-转移 [TNM] 分期+治疗前 EBV-DNA）和 C（TNM 分期+放疗后 EBV-DNA）。

统计学方法

采用 Cox 回归模型进行单因素和多因素分析。基于 Cox 回归模型和两个预后模型建立列线图。采用一致性指数（C-index）和校准曲线评估列线图和 TNM 分期的判别能力。P 值<0.05 为统计学意义。

结果

放疗后 RLN CNN 是 5 年 DMFS 的独立预后因素（危险比，2.88 [1.48-5.62]）。列线图 A（C-index 0.728 [0.660-0.797]）比列线图 B（0.638 [0.571-0.705]）、列线图 C（0.707 [0.636-0.778]）和 TNM 分期（0.587 [0.515-0.659]）对 NPC 患者 5 年 DMFS 的风险区分能力更好。