基于MRI的N1-N2期鼻咽癌颈部中段受累情况：一种风险分层标志物
MRI-based Middle Neck Involvement in Stage N1-N2 Nasopharyngeal Carcinoma: A Marker for Risk Stratification.
作者信息
Qin Guan-Jie, Jiang Wei, Zhang Wu-Qi, Li Wen-Fei, Wang Gao-Yuan, Mao Yan-Ping, Wang Shun-Xin, Dong Zhe, Chen Yu-Pei, Xu Cheng, Yang Kai-Bin, Zhang Yuan, Lu Ying-Qi, Liu Na, Chen Lei, Guo Rui, Tang Ling-Long, Sun Ying, Li Ji-Bin, Liu Li-Zhi, Du Xiao-Jing, Ma Jun
机构信息
Department of Radiation Oncology, 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, No. 651 Dongfeng East Rd, Yuexiu District, Guangzhou 510060, China.
Department of Radiology, 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.
出版信息
Radiology. 2025 Aug;316(2):e243399. doi: 10.1148/radiol.243399.
Background The prognostic implications of middle neck involvement, defined as cervical lymph node metastasis between the caudal border of the hyoid bone and the cricoid cartilage, remain unclear in nasopharyngeal carcinoma (NPC). Purpose To investigate the prognostic significance of middle neck involvement in patients with N1 or N2 NPC. Materials and Methods This retrospective analysis included patients with N1 or N2 NPC without distant metastasis treated between April 2009 and December 2017. Patients were categorized according to the presence or absence of middle neck involvement, as determined at MRI. Survival analysis was performed by incorporating TN category and middle neck involvement. Kaplan-Meier curves and the log-rank test were used to compare survival outcomes. Results This study included 9795 patients (mean age, 45 years ± 11 [SD]; 7135 male). Middle neck involvement was identified in 17.0% of patients (1668 of 9795), with prevalence rates of 11.4% (848 of 7429) in the N1 subgroup and 34.7% (820 of 2366) in the N2 subgroup. Multivariable analysis revealed that middle neck involvement was an independent prognostic factor for reduced metastasis-free survival (MFS), overall survival (OS), and disease-free survival (DFS) in both the N1 (all < .001) and N2 subgroups ( = .001, .02, and .04, respectively). Patients with T1-T2 N1 NPC with middle neck involvement exhibited survival outcomes comparable to those in patients with T1-T2 N2 NPC (all > .05). Conversely, patients with T3N1 disease without middle neck involvement had better 5-year MFS (91.7% vs 84.6%; < .001), OS (90.6% vs 84.3%; = .003), and DFS (83.6% vs 74.4%; < .001) than those with middle neck involvement. Conclusion Middle neck involvement serves as a critical factor for risk stratification in N1 and N2 NPC. It helps identify patients at high risk within the T1-T2 N1 subgroup and those with T3N1 disease. © RSNA, 2025 See also the editorial by Jabehdar Maralani and Kang in this issue.
背景
在鼻咽癌（NPC）中，定义为舌骨尾缘与环状软骨之间颈部淋巴结转移的中颈部受累的预后意义仍不明确。目的：探讨中颈部受累对N1或N2期NPC患者的预后意义。材料与方法：这项回顾性分析纳入了2009年4月至2017年12月期间接受治疗的无远处转移的N1或N2期NPC患者。根据MRI确定的中颈部受累情况对患者进行分类。通过纳入TN分类和中颈部受累情况进行生存分析。采用Kaplan-Meier曲线和对数秩检验比较生存结果。结果：本研究纳入9795例患者（平均年龄45岁±11[标准差]；男性7135例）。17.0%的患者（9795例中的1668例）存在中颈部受累，N1亚组的患病率为11.4%（7429例中的848例），N2亚组为34.7%（2366例中的820例）。多变量分析显示，中颈部受累是N1亚组（所有P均<.001）和N2亚组（分别为P =.001、.02和.04）无转移生存期（MFS）、总生存期（OS）和无病生存期（DFS）降低的独立预后因素。伴有中颈部受累的T1-T2 N1期NPC患者的生存结果与T1-T2 N2期NPC患者相当（所有P均>.05）。相反，不伴有中颈部受累的T3N1期疾病患者的5年MFS（91.7%对84.6%；P<.001）、OS（90.6%对84.3%；P =.003）和DFS（83.6%对74.4%；P<.001）均优于伴有中颈部受累的患者。结论：中颈部受累是N1和N2期NPC风险分层的关键因素。它有助于识别T1-T2 N1亚组中的高危患者以及T3N1期疾病患者。©RSNA，2025 另见本期Jabehdar Maralani和Kang的社论。
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