Prognostic value and staging classification of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy.
Prognostic value and staging classification of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy.
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鼻咽癌调强放疗后咽后淋巴结转移的预后价值及分期分类
DOI：
10.1371/journal.pone.0108375
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Ma J
中科院分区：
文献类型：
--
作者：
Tang LL;Guo R;Zhou G;Sun Y;Liu LZ;Lin AH;Mai H;Shao J;Li L;Ma J
背景调强放射治疗（IMRT）的发展使鼻咽癌的治疗发生了革命性的变化。本研究旨在探讨调强放射治疗时代鼻咽癌咽后淋巴结转移TNM分期的预后价值及分类。材料与方法我们回顾性分析了749例经活检证实的非转移性鼻咽癌患者的资料。所有患者均接受调强放疗作为主要治疗。86.2%（424/492）的III或IV期患者接受了化疗。结果喉返神经转移率为64.2%（481/749）。有、无喉返神经转移者5年无瘤生存率（DFS; 70.6% vs.85.4%，P<0.001）和无远处转移生存率（DMFS; 79.2% vs.90.1%，P<0.001）差异有统计学意义。在多因素分析中，喉返神经转移是疾病失败和远处转移的独立预后因素（分别为P= 0.005和P =0.026），但不是局部复发的独立预后因素。 坏死性喉返神经转移对鼻咽癌喉返神经转移患者的疾病失败、远处失败和局部复发有负性影响（分别为P= 0.003、P = 0.018和P =0.005）。 生存曲线显示，N 0疾病和N1疾病仅RLN转移患者之间的DFS存在显著差异（P = 0.020），N1疾病仅RLN转移和其他N1疾病之间的DMFS和DFS存在边缘统计学显著差异（分别为P= 0.058和P =0.091）。 在N1期，单侧和双侧喉返神经转移的DFS无显著差异（P = 0.994）。 结论在IMRT时代，喉返神经转移仍然是影响鼻咽癌DFS和DMFS的独立预后因素。喉返神经转移被归为N1型仍然是合理的，无论其是否偏侧。然而，有必要在未来通过更大的队列研究来研究将喉返神经转移分类为N1 a疾病的可行性。
Background The development of intensity-modulated radiotherapy (IMRT) has revolutionized the management of nasopharyngeal carcinoma (NPC). The purpose of this study was to evaluate the prognostic value and classification of TNM stage system for retropharyngeal lymph node (RLN) metastasis in NPC in the IMRT era. Material and Methods We retrospectively reviewed data from 749 patients with biopsy-proven, non-metastatic NPC. All patients received IMRT as the primary treatment. Chemotherapy was administered to 86.2% (424/492) of the patients with stage III or IV disease. Results The incidence of RLN metastasis was 64.2% (481/749). Significant differences were observed in the 5-year disease-free survival (DFS; 70.6% vs. 85.4%, P<0.001) and distant metastasis-free survival (DMFS; 79.2% vs. 90.1%, P<0.001) rates of patients with and without RLN metastasis. In multivariate analysis, RLN metastasis was an independent prognostic factor for disease failure and distant failure (P = 0.005 and P = 0.026, respectively), but not for locoregional recurrence. Necrotic RLN metastases have a negative effect on disease failure, distant failure and locoregional recurrence in NPC with RLN metastasis (P = 0.003, P = 0.018 and P = 0.005, respectively). Survival curves demonstrated a significant difference in DFS between patients with N0 disease and N1 disease with only RLN metastasis (P = 0.020), and marginally statistically significant differences in DMFS and DFS between N1 disease with only RLN metastasis and other N1 disease (P = 0.058 and P = 0.091, respectively). In N1 disease, no significant differences in DFS were observed between unilateral and bilateral RLN metastasis (P = 0.994). Conclusions In the IMRT era, RLN metastasis remains an independent prognostic factor for DFS and DMFS in NPC. It is still reasonable for RLN metastasis to be classified in the N1 disease, regardless of laterality. However, there is a need to investigate the feasibility of classifying RLN metastasis as N1a disease in future by a larger cohort study.
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DOI：
10.1016/j.ijrobp.2008.03.017
发表时间：
2008-12-01
影响因子：
7
作者：
Liao, Xin-Biao;Mao, Yan-Ping;Ma, Jun
通讯作者：
Ma, Jun
影响因子：
11.2
作者：
Toustrup, Kasper;Sorensen, Brita Singers;Overgaard, Jens
通讯作者：
Overgaard, Jens
影响因子：
19.7
作者：
King, AD;Tse, GMK;van Hasselt, AC
通讯作者：
van Hasselt, AC
影响因子：
2.6
作者：
DON, DM;ANZAI, Y;CALCATERRA, TC
通讯作者：
CALCATERRA, TC
影响因子：
45.3
作者：
Rischin, D;Hicks, RJ;Peters, LJ
通讯作者：
Peters, LJ