Yan Linghui, Lin Yuhao, Lin Wenrong, Hong Jiabiao, Deng Muling, Chen Chuanben, Fei Zhaodong, Ding Jianming
Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China.
Department of Ultrasound, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China.
Int J Cancer. 2025 Sep 15;157(6):1218-1231. doi: 10.1002/ijc.35470. Epub 2025 May 7.
Parotid lymph node (PLN) metastasis in nasopharyngeal carcinoma (NPC) is rare, with limited data guiding its management and prognosis. We retrospectively analyzed 6924 non-metastatic NPC patients at our tertiary cancer center, identifying 126 patients with PLN metastasis confirmed by fine-needle aspiration cytology (FNAC) and magnetic resonance imaging (MRI). Survival outcomes and prognostic factors were assessed using Kaplan-Meier estimates, log-rank tests, propensity score matching (PSM), and Cox regression. Compared to patients with N3 disease, those with PLN metastasis had worse regional relapse-free survival, distant metastasis-free survival, and progression-free survival. However, overall survival was not significantly affected. When PLN received radical-intensity radiation doses, outcomes were comparable to patients without PLN metastasis. Treatment failures with PLN involvement frequently co-occurred with regional relapse and distant metastasis. Among patients who were treated with PLN-sparing intensity-modulated radiotherapy (IMRT), compared to non-parotid relapse patients, parotid relapse patients were older, had more advanced N classification, lower baseline Epstein-barr virus DNA (EBV-DNA) level, and received fewer cycles of chemotherapy. Additionally, these recurrent PLNs were characterized by smaller size, being typically unilateral and isolated, exhibiting poor sensitivity to chemotherapy, and receiving lower doses of radiotherapy. In our study, PLN metastasis does not upstage the patient's N classification if comprehensive radiotherapy is administered at radical doses. We advise prudence when implementing parotid-sparing IMRT and strongly recommend FNAC for clinically suspicious lesions.
鼻咽癌（NPC）发生腮腺淋巴结（PLN）转移较为罕见，指导其治疗和预后的数据有限。我们回顾性分析了我院三级癌症中心的6924例非转移性NPC患者，确定了126例经细针穿刺细胞学检查（FNAC）和磁共振成像（MRI）确诊为PLN转移的患者。采用Kaplan-Meier估计、对数秩检验、倾向评分匹配（PSM）和Cox回归评估生存结局和预后因素。与N3期疾病患者相比，PLN转移患者的区域无复发生存率、远处无转移生存率和无进展生存率更差。然而，总生存未受到显著影响。当PLN接受根治性放疗剂量时，其结局与无PLN转移的患者相当。PLN受累导致的治疗失败常与区域复发和远处转移同时发生。在接受保留PLN的调强放疗（IMRT）治疗的患者中，与非腮腺复发患者相比，腮腺复发患者年龄更大、N分期更晚、基线爱泼斯坦-巴尔病毒DNA（EBV-DNA）水平更低且接受的化疗周期更少。此外，这些复发的PLN具有体积较小的特点，通常为单侧且孤立，对化疗敏感性差且接受的放疗剂量较低。在我们的研究中，如果以根治剂量进行综合放疗，PLN转移不会使患者的N分期升级。我们建议在实施保留腮腺的IMRT时要谨慎，并强烈推荐对临床可疑病变进行FNAC检查。
