Cancer Res Treat.  2019 Jul;51(3):1222-1230. 10.4143/crt.2018.595.

Prognostic Value and Staging Classification of Lymph Nodal Necrosis in Nasopharyngeal Carcinoma after Intensity-Modulated Radiotherapy

• Feng Y
• Cao C
• Hu Q
• Chen X

• KMID: 2454313
• DOI: http://doi.org/10.4143/crt.2018.595

Abstract

PURPOSE
The aim of the present study was to evaluate the prognostic value of magnetic resonance imaging (MRI)"’determined lymph nodal necrosis (LNN) in nasopharyngeal carcinoma (NPC) and explore the feasibility of an N-classification system based on the 8th edition of the American Joint Committee on Cancer (AJCC) system.
MATERIALS AND METHODS
The MRI scans of 616 patients with newly diagnosed stage T1-4N1-3M0 NPC who were treated with definitive intensity-modulated radiotherapy (IMRT) were reviewed.
RESULTS
Multivariate analysis showed that LNN was an independent negative prognostic predictor of distant metastasis free survival (hazard ratio, 1.634; 95% confidence interval, 1.023 to 2.609; p=0.040) and overall survival (hazard ratio, 2.154; 95% confidence interval, 1.282 to 3.620; p=0.004). Patients of classification N1 disease with LNN were reclassified as classification N2, and classification N2 disease with LNN as classification N3 in the proposed N-classification system. Correlation with death and distant failure was significant, and the total difference between N1 and N3 was wider with the proposed system.
CONCLUSION
MRI-determined LNN is an independent negative prognostic factor for NPC. The proposed N classification system is powerfully predictive.

Keyword

Nasopharyngeal carcinoma; Lymph nodes; Intensity-modulated radiotherapy; Prognosis; Neoplasm staging

MeSH Terms

Classification*
Humans
Joints
Lymph Nodes
Magnetic Resonance Imaging
Multivariate Analysis
Necrosis*
Neoplasm Metastasis
Neoplasm Staging
Prognosis
Radiotherapy, Intensity-Modulated*

Figure

• 

  Fig. 1. Necrotic lymph nodes in two patients with nasopharyngeal carcinoma. Axial T2-weighted (A) and contrast-enhanced T1-weighted (B) magnetic resonance (MR) images in a 43-year-old woman show the left retropharyngeal lymph node with necrosis (arrows). Axial T2-weighted (C) and contrast-enhanced T1-weighted (D) MR images in a 40-year-old man show necrotic lymph nodes in the bilateral level II area (arrows).

• 

  Fig. 2. Kaplan-Meier curves show locoregional failure-free survival (LRFFS) (A), distant metastasis-free survival (DMFS) (B), and overall survival (OS) (C) rates for the lymph nodal necrosis (LNN) and non-LNN groups. HR, hazard ratio; CI, confidence interval.

Reference

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