Nasopharyngeal Head and Neck Tumor Radiotherapy Department, Zhongshan City People's Hospital, Zhongshan, P. R. China.
State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangdong 510060, P. R. China.
AJR Am J Roentgenol. 2024 Jan;222(1):e2329984. doi: 10.2214/AJR.23.29984. Epub 2023 Sep 27.
Retropharyngeal lymph node (RLN) metastases have profound prognostic implications in patients with nasopharyngeal carcinoma (NPC). However, the AJCC staging system does not specify a size threshold for determining RLN involvement, resulting in inconsistent thresholds in practice. The purpose of this article was to determine the optimal size threshold for determining the presence of metastatic RLNs on MRI in patients with NPC, in terms of outcome predictions. This retrospective study included 1752 patients (median age, 46 years; 1297 men, 455 women) with NPC treated by intensity-modulated radiotherapy (RT) from January 2010 to March 2014 from two hospitals; 438 patients underwent MRI 3-4 months after treatment. Two radiologists measured the minimal axial diameter (MAD) of the largest RLN for each patient using a consensus process. A third radiologist measured MAD in 260 randomly selected patients to assess interobserver agreement. Initial ROC and restricted cubic spline (RCS) analyses were used to derive an optimal MAD threshold for predicting progression-free survival (PFS). The threshold's predictive utility was assessed in multivariable Cox regression analyses, controlling for standard clinical predictors. The threshold's utility for predicting PFS and overall survival (OS) was compared with a 5-mm threshold using Kaplan-Meier curves and log-rank tests. The intraclass correlation coefficient for MAD was 0.943. ROC and RCS analyses yielded an optimal threshold of 6 mm. In multivariable analyses, MAD of 6 mm and greater independently predicted PFS in all patients (HR = 1.35, = .02), patients with N0 or N1 disease (HR = 1.80, = .008), and patients who underwent posttreatment MRI (HR = 1.68, = .04). In patients with N1 disease without cervical lymph node involvement, 5-year PFS was worse for MAD greater than or equal to 6 mm than for MAD that was greater than or equal to 5 mm but less than 6 mm (77.2% vs 89.7%, = .03). OS was significantly different in patients with stage I and stage II disease defined using a 6-mm threshold ( = .04), but not using a 5-mm threshold ( = .09). The 5-year PFS rate was associated with a post-RT MAD of 6 mm and greater (HR = 1.68, = .04) but not a post-RT MAD greater than or equal to 5 mm (HR = 1.09, = .71). The findings support a threshold MAD of 6 mm for determining RLN involvement in patients with NPC. Future AJCC staging updates should consider incorporation of the 6-mm threshold for N-category and tumor-stage determinations.
颈部后淋巴结 (RLN) 转移对鼻咽癌 (NPC) 患者的预后具有深远影响。然而，AJCC 分期系统并未指定确定 RLN 受累的大小阈值，导致在实践中存在不一致的阈值。本文的目的是确定在 NPC 患者的 MRI 上确定存在转移性 RLN 的最佳大小阈值，以预测结果。这项回顾性研究纳入了 1752 名（中位年龄 46 岁；1297 名男性，455 名女性）接受调强放疗（RT）治疗的 NPC 患者，治疗时间为 2010 年 1 月至 2014 年 3 月，来自两家医院；438 名患者在治疗后 3-4 个月接受 MRI 检查。两名放射科医生使用共识过程测量每位患者最大 RLN 的最小轴向直径（MAD）。第三名放射科医生测量了 260 名随机选择患者的 MAD，以评估观察者间的一致性。初始 ROC 和限制性立方样条（RCS）分析用于得出用于预测无进展生存期（PFS）的最佳 MAD 阈值。使用多变量 Cox 回归分析，在控制标准临床预测因素的情况下，评估该阈值的预测效用。使用 Kaplan-Meier 曲线和对数秩检验，将该阈值用于预测 PFS 和总生存期（OS）的效用与 5-mm 阈值进行比较。MAD 的组内相关系数为 0.943。ROC 和 RCS 分析得出最佳阈值为 6mm。在多变量分析中，MAD 为 6mm 及以上可独立预测所有患者的 PFS（HR = 1.35，P =.02）、N0 或 N1 疾病患者的 PFS（HR = 1.80，P =.008）和接受治疗后 MRI 检查的患者的 PFS（HR = 1.68，P =.04）。在无颈淋巴结受累的 N1 疾病患者中，MAD 大于或等于 6mm 比 MAD 大于或等于 5mm 但小于 6mm 的患者的 5 年 PFS 更差（77.2%比 89.7%，P =.03）。使用 6mm 阈值定义的 I 期和 II 期疾病患者的 OS 显著不同（P =.04），但使用 5mm 阈值定义的 OS 没有显著不同（P =.09）。接受 RT 后 MAD 为 6mm 及以上与 PFS 相关（HR = 1.68，P =.04），而接受 RT 后 MAD 大于或等于 5mm 与 PFS 无关（HR = 1.09，P =.71）。研究结果支持 NPC 患者 RLN 受累的 6mm 阈值。未来的 AJCC 分期更新应考虑将 6mm 阈值纳入 N 类别和肿瘤分期的确定。
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