Integrating pretreatment MRI-detected nodal features and Epstein-Barr virus DNA to identify optimal candidates for intensity-modulated radiotherapy alone in patients with stage II nasopharyngeal carcinoma
Integrating pretreatment MRI-detected nodal features and Epstein-Barr virus DNA to identify optimal candidates for intensity-modulated radiotherapy alone in patients with stage II nasopharyngeal carcinoma
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DOI：
10.1016/j.oraloncology.2023.106574
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发表时间：
2023-09-22
期刊：
影响因子：
4.8
通讯作者：
Yang，Qi
中科院分区：
文献类型：
--
作者：
Guo，Jia;He，Yun;Yang，Qi
目的 根据 MRI 检测到的 II 期鼻咽癌 (NPC) 患者的咽后和颈部淋巴结特征以及 Epstein-Barr 病毒 (EBV) DNA 特征，开发和验证预后列线图，以区分仅进行调强放疗 (IMRT) 就足够的低风险患者。 方法 这项回顾性研究纳入了 894 名 II 期 NPC 患者（训练组和验证组分别为 596 例和 298 例，分别）在 2010 年 8 月至 2019 年 5 月期间进行治疗前 MRI。所有患者均接受 IMRT，伴或不伴额外化疗。我们使用单变量和多变量 Cox 回归分析确定了独立风险因素。使用 Kaplan-Meier 曲线和对数秩检验比较生存率。 结果多变量分析得出的独立因素包括颈部淋巴结坏死 (CNN)、颈部和咽后淋巴结的囊外扩散 (ECS) 以及 γ-谷氨酰转移酶 (γ-GGT)。列线图 A、B 和 C 分别基于临床 [肿瘤淋巴结转移 (TNM) 分期 + Epstein-Barr 病毒 (EBV) DNA]、临床放射学 [所有独立预测因子] 和组合模型 [临床放射学模型 + EBV DNA] 建立。列线图 C（C 指数 0.769 [0.718–0.820]）表现出比列线图 B（0.762 [0.715–0.809]）、列线图 A（0.619 [0.564–0.674]）和 TNM 分期（0.560 [0.509–0.611]）更好的风险辨别能力。在按列线图 C 划分的低风险组中，仅接受放疗 (RT) 治疗的患者与接受其他方案（包括额外化疗）的患者之间没有观察到显着的生存差异。 结论 将 MRI 检测到的咽后和颈部淋巴结特征与治疗前 EBV-DNA 相结合的列线图改善了 II 期 NPC 的预后风险分层。
ObjectivesTo develop and validate a prognostic nomogram based on MRI-detected features of retropharyngeal and cervical lymph nodes and Epstein–Barr virus (EBV) DNA in patients with stage II nasopharyngeal carcinoma (NPC) to distinguish low-risk patients for whom intensity-modulated radiotherapy (IMRT) alone is sufficient.MethodsThis retrospective study enrolled 894 patients with stage II NPC (596 and 298 in the training and validation cohorts, respectively) with pretreatment MRI between August 2010 and May 2019. All patients received IMRT with or without additional chemotherapy. We identified independent risk factors using univariate and multivariate Cox regression analyses. Survival was compared using Kaplan–Meier curves with the log-rank test.ResultsIndependent factors derived from the multivariate analysis include cervical nodal necrosis (CNN), the extracapsular spread (ECS) of cervical and retropharyngeal lymph nodes, and gamma-glutamyl transferase (γ-GGT). Nomograms A, B, and C were established based on the clinical [tumor-node-metastasis (TNM) stage + Epstein–Barr virus (EBV) DNA], the clinical-radiological [all independent predictors] and the combined models [the clinical-radiological model + EBV DNA], respectively. Nomogram C (C-index 0.769 [0.718–0.820]) demonstrated better risk discrimination than nomogram B (0.762 [0.715–0.809]), nomogram A (0.619 [0.564–0.674]), and the TNM stage (0.560 [0.509–0.611]). In the low-risk group divided by nomogram C, no significant survival differences were observed between patients treated with radiotherapy (RT) alone and other regimens including additional chemotherapy.ConclusionsThe nomogram combining MRI-detected retropharyngeal and cervical lymph node features with pretreatment EBV-DNA improved the prognostic risk stratification for stage II NPC.