Prognostic value of MRI-derived masticator space involvement in IMRT-treated nasopharyngeal carcinoma patients.
Prognostic value of MRI-derived masticator space involvement in IMRT-treated nasopharyngeal carcinoma patients.
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DOI：
10.1186/s13014-015-0513-6
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发表时间：
2015-09-25
期刊：
影响因子：
--
通讯作者：
Tang L
中科院分区：
文献类型：
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作者：
Xiao Y;Pan J;Chen Y;Lin S;Chen Y;Zong J;Fang Y;Guo Q;Chen B;Tang L
本回顾性研究重新评估接受调强放射治疗（IMRT）的鼻咽癌（NPC）患者，以确定磁共振成像（MRI）衍生的咀嚼肌间隙受累（MSI）对患者预后的影响。纳入1197例有完整MRI和病历的NPC患者。根据他们的MRI结果，根据第七版美国癌症联合委员会分期系统确定肿瘤的T类，该系统认为MSI是NPC的预后指标。Kaplan-Meier法分析总生存率（OS）、局部无复发生存率（LRFS）、区域无复发生存率（RRFS）和无远处转移生存率（DMFS），Log-Rank检验比较其差异。采用考克斯回归分析系统评价各种预后因素。采用SPSS18.0软件进行统计学分析，P < 0.05为有统计学意义。翼内肌受累283例（23.64%），其中翼外肌受累181例（15.12%），颞下窝受累19例（1.59%）. MSI与OS、LRFS和DMFS相关，与T4分期诊断一致（P > 0.05）。尽管不同程度的MSI的OS和DMFS相似（P > 0.1），但累及LPM的肿瘤的LRFS比仅累及MPM的肿瘤差（P = 0.027），即使是T3和T4亚组（P = 0.035）。MPM的LRFS与T2或T3期疾病一致（P > 0.1）。如果肿瘤同时累及LPM或ITF，则生存结局更符合T4期疾病（P > 0.1）。然而，与肿瘤浸润性MPM相比，侵袭LPM或ITF的肿瘤更频繁地扩散到其他获得更高T分期类别的并发部位。多因素分析显示MSI程度是影响NPC OS的重要预后因素（P = 0.036）。MSI的程度是IMRT治疗NPC的OS的重要指标，并且MSI侧向扩展（LPM和ITF）患者的预后显着差于仅受影响的MPM或T3期疾病。因此，强烈建议将外侧MSI扩展作为更高的T分期类别。
This retrospective study reassessed nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiation therapy (IMRT), to determine the significance how magnetic resonance imaging (MRI)-derived masticator space involvement (MSI) affected patients’ prognosis. One thousand one hundred ninety seven NPC patients who had complete set of MRI and medical records were enrolled. Basing on their MRI findings, the T-categories of tumors were identified according to the seventh edition of American Joint Committee on Cancer staging system, which considers MSI a prognostic indicator for NPCs. Rates of overall survival (OS), local relapse-free survival (LRFS), regional relapse-free survival (RRFS) and distant metastasis-free survival (DMFS) were analyzed by the Kaplan-Meier method, and the Log-Rank test compared their differences. Cox regression analysis was employed to evaluate various prognostic factors systematically. Statistical analyses were conducted with SPSS 18.0 software, P value < 0.05 was considered statistically significant. Medial pterygoid muscle (MPM) was involved in 283 (23.64 %) cases, of which lateral pterygoid muscle (LPM) was concurrently affected in 181 (15.12 %) and infratemporal fossa (ITF) in 19 (1.59 %). Generally, MSI correlated with an OS, LRFS, and DMFS consistent with a T4-stage diagnosis (P > 0.05). Although different degrees of MSI presented a similar OS and DMFS (P > 0.1), tumors involving LPM had a relatively poorer LRFS than those affected the MPM only (P = 0.027), even for subgroup of patients composed of T3 and T4 classifications (P = 0.035). A tumor involving MPM brought an LRFS consistent with a T2 or T3-stage disease (P > 0.1). If the tumor affected LPM or ITF concurrently, the survival outcomes were more consistent with a T4-stage disease (P > 0.1). Nevertheless, compared to tumor infiltrating MPM, those invading LPM or ITF more frequently spread into other concurrent sites that earned higher T-staging categories. Moreover, multivariate analyses indicated the degree of MSI was a significant prognostic factor for the OS of NPCs (P = 0.036). Degree of MSI is a significant prognosticator for the OS of IMRT-treated NPCs, and the prognosis of patients with lateral MSI extension (LPM and ITF) were shown to be significantly worse than those affected only MPM or the T3-stage disease. Thus, it is highly recommended that lateral MSI extension be a higher T-staging category.