鼻咽癌颈部淋巴结坏死率的预后价值。

Prognostic value of the cervical lymph node necrosis ratio in nasopharyngeal carcinoma.

机构信息

Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China; Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, Guangxi, China; Department of Oncology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, 530021, Guangxi, China.

出版信息

Radiother Oncol. 2022 Dec;177:185-190. doi: 10.1016/j.radonc.2022.11.007. Epub 2022 Nov 12.

DOI:10.1016/j.radonc.2022.11.007

PMID:36375560

Abstract

PURPOSE

Whether cervical lymph node necrosis (CNN) is an independent adverse prognostic factor in nasopharyngeal carcinoma (NPC) has not been determined. In this study, the CNN ratio was graded quantitatively to explore the prognostic value in NPC.

PARTICIPANTS AND METHODS

We retrospectively reviewed a total of 648 pathologically confirmed as NPC. We outlined metastatic lymph nodes and necrotic area of lymph nodes slice by slice on the magneticresonanceimages (MRI) cross section, and calculated the corresponding CNN ratio.

RESULTS

The median CNN ratio (17.37 %) was taken as the cut-off point, 256 (39.51 %) patients were divided into CNN1 group (<17.37 %, n = 128) and CNN2 group (≥17.37 %, n = 128), 392 (60.49 %) patients without lymph nodes necrosis were CNN0. Among the CNN0, CNN1 and CNN2 groups, five-year overall survival (OS) was 82.4 %, 76.6 % and 71.1 %, locoregional recurrence-free survival (LRRFS) was 91.3 %, 91.1 % and 90.5 %, distant metastasis-free survival (DMFS) was 83.7 %, 78.5 % and 68.7 %, progression-free survival (PFS) was 78.3 %, 71.7 % and 61.6 % respectively. By multivariate analysis, CNN was an independent prognostic factor for OS (P = 0.003), DMFS (P = 0.019) and PFS (P = 0.007). More than 3 cycles of chemotherapy significantly increased OS (P = 0.024) and DMFS (P = 0.015) in the CNN1 group.

CONCLUSIONS

This study indicated that CNN is one of the factors with the negative prognosis of NPC. The CNN ratio might be used as one of the reference factors in the formulation of individualized treatment plan.

摘要

目的

颈部淋巴结坏死（CNN）是否是鼻咽癌（NPC）的独立不良预后因素尚未确定。在本研究中，通过对 CNN 比进行定量分级，来探讨其在 NPC 中的预后价值。

参与者和方法

我们回顾性分析了 648 例经病理证实为 NPC 的患者。我们对 MRI 横断位上的转移性淋巴结和淋巴结坏死区进行逐层勾画，并计算相应的 CNN 比。

结果

以中位数 CNN 比（17.37%）为界点，256 例（39.51%）患者分为 CNN1 组（<17.37%，n=128）和 CNN2 组（≥17.37%，n=128），392 例（60.49%）无淋巴结坏死的患者为 CNN0。在 CNN0、CNN1 和 CNN2 组中，5 年总生存率（OS）分别为 82.4%、76.6%和 71.1%，局部区域无复发生存率（LRRFS）分别为 91.3%、91.1%和 90.5%，无远处转移生存率（DMFS）分别为 83.7%、78.5%和 68.7%，无进展生存率（PFS）分别为 78.3%、71.7%和 61.6%。多因素分析显示，CNN 是 OS（P=0.003）、DMFS（P=0.019）和 PFS（P=0.007）的独立预后因素。在 CNN1 组中，化疗超过 3 个周期可显著提高 OS（P=0.024）和 DMFS（P=0.015）。