Prognostic value and the potential role of treatment options for cervical lymph node necrosis in nasopharyngeal carcinoma
Prognostic value and the potential role of treatment options for cervical lymph node necrosis in nasopharyngeal carcinoma
复制标题
鼻咽癌颈部淋巴结坏死治疗方案的预后价值和潜在作用
DOI：
10.1016/j.oraloncology.2020.104864
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发表时间：
2020-10-01
期刊：
影响因子：
4.8
通讯作者：
Lv, Xing
中科院分区：
文献类型：
--
作者：
Liu, Kuiyuan;Lin, Siting;Lv, Xing
目的：在调强放射治疗（IMRT）时代，针对鼻咽癌（NPC）患者颈部淋巴结坏死（CNN）的研究很少，以建立诺模图并指导治疗决策。CNN在训练队列中的预后准确性（n = 1940）在广州内部验证队列（n = 832）和两个外部验证队列中进行了验证结果：主要终点为无进展生存期（PFS），采用Kaplan-Meier法计算。在中位60.0个月的随访后，训练队列中的CNN患者的5年PFS（70.8% vs. 89.1%，P < 0.001）比没有CNN的患者差，这在验证队列中得到了验证。基于CNN的列线图预测个体PFS风险（培训：C指数0.733;广州验证：C指数0.736;佛山：C指数0.722;东莞：C指数0.756）。对于N2期患者和IV期患者，无论CNN状态如何，诱导化疗（ICT）和CCRT的PFS均优于CCRT（P < 0.05）。CNN组中的N2患者和IV期患者可能从ICT中获得生存益处。
Objective: There were few studies focused on the cervical lymph necrosis (CNN) of nasopharyngeal carcinoma (NPC) patients to develop a nomogram and guide the treatment decision at the era of intensity modulated radiation therapy (IMRT).Material and Methods: The prognostic accuracy of CNN in the training cohort (n = 1940) was validated in Guangzhou internal validation cohort (n = 832) and two external validation cohorts (Dongguan, n = 232; Foshan, n = 134).Results: The primary end point was progression-free survival (PFS), calculated using the Kaplan-Meier method. After a median 60.0 months' follow-up, patients with CNN in the training cohort had worse 5-year PFS (70.8% vs. 89.1%, P < 0.001) than patients without CNN, which was validated in the validation cohorts. The nomogram based on CNN predicted an individual PFS risk (training: C-index 0.733; Guangzhou validation: C-index 0.736; Foshan: C-index 0.722; Dongguan: C-index 0.756). Stage N2 patients in the CNN group and stage IV patients no matter the status of CNN, PFS was better with induction chemotherapy (ICT) and CCRT than CCRT (P < 0.05).Conclusion: Taken together, CNN reliably predicts survival risk in NPC patients. N2 patients in the CNN group and stage IV patients may receive survival benefit from ICT.