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 510060, PR China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
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 510060, PR China; Department of Imaging, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
Oral Oncol. 2023 Nov;146:106574. doi: 10.1016/j.oraloncology.2023.106574. Epub 2023 Sep 22.
To develop and validate a prognostic nomogram based on MRI-detected features of retropharyngeal and cervical lymph nodes and Epstein-Barr virus (EBV) DNA in patients with stage II nasopharyngeal carcinoma (NPC) to distinguish low-risk patients for whom intensity-modulated radiotherapy (IMRT) alone is sufficient.
This retrospective study enrolled 894 patients with stage II NPC (596 and 298 in the training and validation cohorts, respectively) with pretreatment MRI between August 2010 and May 2019. All patients received IMRT with or without additional chemotherapy. We identified independent risk factors using univariate and multivariate Cox regression analyses. Survival was compared using Kaplan-Meier curves with the log-rank test.
Independent factors derived from the multivariate analysis include cervical nodal necrosis (CNN), the extracapsular spread (ECS) of cervical and retropharyngeal lymph nodes, and gamma-glutamyl transferase (γ-GGT). Nomograms A, B, and C were established based on the clinical [tumor-node-metastasis (TNM) stage + Epstein-Barr virus (EBV) DNA], the clinical-radiological [all independent predictors] and the combined models [the clinical-radiological model + EBV DNA], respectively. Nomogram C (C-index 0.769 [0.718-0.820]) demonstrated better risk discrimination than nomogram B (0.762 [0.715-0.809]), nomogram A (0.619 [0.564-0.674]), and the TNM stage (0.560 [0.509-0.611]). In the low-risk group divided by nomogram C, no significant survival differences were observed between patients treated with radiotherapy (RT) alone and other regimens including additional chemotherapy.
The nomogram combining MRI-detected retropharyngeal and cervical lymph node features with pretreatment EBV-DNA improved the prognostic risk stratification for stage II NPC.
基于 MRI 检测的咽后和颈部淋巴结特征以及 Epstein-Barr 病毒 (EBV) DNA，建立并验证一个针对 II 期鼻咽癌 (NPC) 患者的预后列线图，以区分低危患者，这些患者单纯接受调强放疗 (IMRT) 即可。
本回顾性研究纳入了 2010 年 8 月至 2019 年 5 月间接受治疗的 894 例 II 期 NPC 患者（训练队列 596 例，验证队列 298 例），所有患者均接受了 IMRT 联合或不联合化疗。我们采用单因素和多因素 Cox 回归分析确定独立的危险因素。采用 Kaplan-Meier 曲线和对数秩检验比较生存情况。
多因素分析得出的独立因素包括颈部淋巴结坏死（CNN）、颈部和咽后淋巴结的包膜外扩散（ECS）以及γ-谷氨酰转移酶（γ-GGT）。基于临床 [肿瘤-淋巴结-转移 (TNM) 分期+EBV DNA]、临床-影像学 [所有独立预测因素] 和联合模型 [临床-影像学模型+EBV DNA]，分别建立了列线图 A、B 和 C。列线图 C（C 指数 0.769 [0.718-0.820]）的风险判别能力优于列线图 B（0.762 [0.715-0.809]）、列线图 A（0.619 [0.564-0.674]）和 TNM 分期（0.560 [0.509-0.611]）。根据列线图 C 划分的低危组中，接受单纯放疗（RT）与其他方案（包括辅助化疗）的患者之间，生存情况无显著差异。
该列线图结合了 MRI 检测的咽后和颈部淋巴结特征以及 EBV-DNA，提高了 II 期 NPC 的预后风险分层。
