Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Clin Cancer Res. 2024 May 1;30(9):1801-1810. doi: 10.1158/1078-0432.CCR-23-3274.
To determine the potential nodal drainage distances of nasopharyngeal carcinoma (NPC) by investigating spatial distribution of metastatic lymph nodes (LN).
Patients with NPC harboring at least two ipsilateral metastatic LNs were enrolled. LN spreading distances were analyzed in nonrestricted direction, cranial-to-caudal direction, and between the two most caudal LNs. Euclidean distance (ED) and vertical distance (VD) between any two LNs were computed. The nearest-neighbor ED and VD covering 95% of LNs or patients (p95-ED and p95-VD) were considered drainage distances, and were further validated by independent internal and external cohorts with recurrent LNs.
In all, 5,836 metastatic LNs in 948 patients were contoured. Corresponding to the three scenarios, per-LN level, the p95-EDs were 2.83, 3.28, and 3.55 cm, and p95-VDs were 2.17, 2.32, and 2.63 cm, respectively. Per-patient level, the p95-EDs were 3.25, 3.95, and 3.81 cm, and p95-VDs were 2.67, 2.81, and 2.73 cm, respectively. In internal validation, over 95% of recurred LNs occurred within ED of 2.91 cm and VD of 0.82 cm to the neighbor LN, and the corresponding distances in external validation were 2.77 and 0.67 cm, respectively.
In NPC, the maximum LN drainage distance was 3.95 cm without considering the direction. Specifically, in cranial-to-caudal direction, the sufficient vertical drainage distance was 2.81 cm, indicating that a 3-cm extension from the most inferior node may be rational as caudal border of the prophylactic clinical target volume (CTV). These findings promote in-depth understanding of nodal spreading patterns, uncovering paramount evidence for individualized CTV.
通过研究转移性淋巴结（LN）的空间分布，确定鼻咽癌（NPC）的潜在淋巴结引流距离。
入组至少有 2 个同侧转移性 LN 的 NPC 患者。分析 LN 在不受限制的方向、颅尾方向以及两个最尾侧 LN 之间的扩散距离。计算任意两个 LN 之间的欧几里得距离（ED）和垂直距离（VD）。覆盖 95%LN 或患者的最近邻 ED 和 VD（p95-ED 和 p95-VD）被认为是引流距离，并通过具有复发性 LN 的独立内部和外部队列进行进一步验证。
共描绘了 948 例患者的 5836 个转移性 LN。对应于三种情况，每 LN 水平，p95-ED 分别为 2.83、3.28 和 3.55cm，p95-VD 分别为 2.17、2.32 和 2.63cm。每患者水平，p95-ED 分别为 3.25、3.95 和 3.81cm，p95-VD 分别为 2.67、2.81 和 2.73cm。在内部验证中，超过 95%的复发性 LN 发生在距离相邻 LN 的 ED 为 2.91cm 和 VD 为 0.82cm 以内，外部验证中的相应距离分别为 2.77cm 和 0.67cm。
在 NPC 中，不考虑方向的情况下，LN 最大引流距离为 3.95cm。具体而言，在颅尾方向上，足够的垂直引流距离为 2.81cm，表明从最下节点向后延伸 3cm 可能是预防性临床靶区（CTV）尾侧边界的合理选择。这些发现促进了对淋巴结扩散模式的深入理解，为个体化 CTV 提供了至关重要的证据。
