Yang Hui, Liang Zhiying, Liang Jiahui, Cao Di, Cao Qin, Zhao Feng, Zhang Weijing, Kou Kit Ian, Cui Chunyan, Liu Lizhi, Li Haojiang, Peng Zexue, Zhu Siyu
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, Guangzhou, China.
Department of Hepatobiliary Oncology, The People's Hospital of Yingcheng, Yingcheng, China.
Quant Imaging Med Surg. 2024 Aug 1;14(8):5513-5525. doi: 10.21037/qims-24-275. Epub 2024 Jul 17.
Among patients with nasopharyngeal carcinoma (NPC), there is no established method to distinguish between patients with residual disease that may eventually progress and those who have achieved cured. We thus aimed to assess the prognostic value of magnetic resonance imaging (MRI)-based lymph node regression grade (LRG) in the risk stratification of patients with NPC following radiotherapy (RT).
This study retrospectively enrolled 387 patients newly diagnosed with NPC between January 2010 and January 2013. A four-category MRI-LRG system based on the areal analysis of RT-induced fibrosis and residual tumor was established. Univariate analysis was performed using the Kaplan-Meier method, and comparisons were conducted via the log-rank test. Multivariate analyses were conducted using Cox regression models to calculate the hazard ratios (HRs) with 95% confidence intervals (CIs) and adjusted P values. Survival curves were calculated using the Kaplan-Meier method and compared using the log-rank test.
The sum of MRI-LRG scores (LRG-sum) was an independent prognostic factor for progression-free survival (PFS) (HR 2.50, 95% CI: 1.28-4.90; P<0.001). LRG-sum ≤9 and >9 showed a poorer 5-year PFS rate than did LRG-sum ≤2 (66.1%, 42.9%, and 77.6%, respectively; P<0.001). A survival clustering analysis-based decision tree model showed more complex interactions among LRG-sum and pretreatment and post-RT Epstein-Barr virus (EBV) DNA, yielding four patient clusters with differentiated disease progression risks (5-year PFS rates of 89.5%, 76.4%, 57.6%, and 27.8%, respectively), which showed better risk stratification than did post-RT EBV DNA alone (P<0.001).
The MRI-LRG system adds prognostic information and is a potentially reliable, noninvasive means to stratify treatment modalities for patients with NPC.
在鼻咽癌（NPC）患者中，尚无既定方法可区分最终可能进展的残留病灶患者和已治愈患者。因此，我们旨在评估基于磁共振成像（MRI）的淋巴结消退分级（LRG）在鼻咽癌患者放疗（RT）后风险分层中的预后价值。
本研究回顾性纳入了2010年1月至2013年1月期间新诊断为NPC的387例患者。基于放疗诱导的纤维化和残留肿瘤的面积分析，建立了一个四类MRI-LRG系统。采用Kaplan-Meier方法进行单因素分析，并通过对数秩检验进行比较。使用Cox回归模型进行多因素分析，以计算风险比（HRs）及其95%置信区间（CIs）和校正P值。使用Kaplan-Meier方法计算生存曲线，并通过对数秩检验进行比较。
MRI-LRG评分总和（LRG-sum）是无进展生存期（PFS）的独立预后因素（HR 2.50，95%CI：1.28-4.90；P<0.001）。LRG-sum≤9和>9的患者5年PFS率低于LRG-sum≤2的患者（分别为66.1%、42.9%和77.6%；P<0.001）。基于生存聚类分析的决策树模型显示，LRG-sum与放疗前和放疗后爱泼斯坦-巴尔病毒（EBV）DNA之间存在更复杂的相互作用，产生了四个疾病进展风险不同的患者亚组（5年PFS率分别为89.5%、76.4%、57.6%和27.8%），其风险分层优于单纯放疗后EBV DNA（P<0.001）。
MRI-LRG系统增加了预后信息，是一种潜在可靠的、非侵入性的手段，可用于鼻咽癌患者治疗方式的分层。
