Influence of tumor necrosis on treatment sensitivity and long-term survival in nasopharyngeal carcinoma

Liang, Shuli; Chen, Lusi; Yang, Xiaoxi; Chen, Dan-Ming; Wang, Donghui; Cui, Chunyan; Xie, Chuanbo; Liu, Lizhi; Xu, Xiangying

doi:10.1016/j.radonc.2020.11.011

Cited by 26 publications

(23 citation statements)

References 27 publications

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“…These studies have gone further to investigate the prognostic values of nodal characteristics in detail [ 42 – 46 ]. Necrosis is easily observed in metastatic nodes from NPC but very rarely in primary tumour (about 2%) on the pre-treatment staging MRI [ 34 ]. Tang et al [ 25 ] reported that CNN was observed in 13% patients with metastatic retropharyngeal nodes, and the current study showed that the incidence of CNN rate was about 42% in patients with metastatic nodes.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of cervical nodal necrosis on staging imaging of nasopharyngeal carcinoma in era of intensity-modulated radiotherapy: a systematic review and meta-analysis

Hung

et al. 2022

Cancer Imaging

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Purposes To systematically review and perform meta-analysis to evaluate the prognostic value of cervical nodal necrosis (CNN) on the staging computed tomography/magnetic resonance imaging (MRI) of nasopharyngeal carcinoma (NPC) in era of intensity-modulated radiotherapy. Methods Literature search through PubMed, EMBASE, and Cochrane Library was conducted. The hazard ratios (HRs) with 95% confidence intervals (CIs) of CNN for distant metastasis-free survival (DMFS), disease free survival (DFS) and overall survival (OS) were extracted from the eligible studies and meta-analysis was performed to evaluate the pooled HRs with 95%CI. Results Nine studies, which investigated the prognostic values of 6 CNN patterns on MRI were included. Six/9 studies were eligible for meta-analysis, which investigated the CNN presence/absence in any nodal group among 4359 patients. The pooled unadjusted HRs showed that the CNN presence predicted poor DMFS (HR =1.89, 95%CI =1.72-2.08), DFS (HR =1.57, 95%CI =1.08-2.26), and OS (HR =1.87, 95%CI =1.69-2.06). The pooled adjusted HRs also showed the consistent results for DMFS (HR =1.34, 95%CI =1.17-1.54), DFS (HR =1.30, 95%CI =1.08-1.56), and OS (HR =1.61, 95%CI =1.27-2.04). Results shown in the other studies analysing different CNN patterns indicated the high grade of CNN predicted poor outcome, but meta-analysis was unable to perform because of the heterogeneity of the analysed CNN patterns. Conclusion The CNN observed on the staging MRI is a negative factor for NPC outcome, suggesting that the inclusion of CNN is important in the future survival analysis. However, whether and how should CNN be included in the staging system warrant further evaluation.

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Section: Discussionmentioning

confidence: 99%

Prognostic value of cervical nodal necrosis on staging imaging of nasopharyngeal carcinoma in era of intensity-modulated radiotherapy: a systematic review and meta-analysis

Hung

et al. 2022

Cancer Imaging

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“…In addition, it has been reported that tumor necrosis may reflect hypoxia and radioresistance, thus might be an excellent predictor for NPC treatment failure 32–36 . However, few studies have assessed the predictive value of GTVnd combined with CNN status for regional failure.…”

Section: Discussionmentioning

confidence: 99%

Tumor factors associated with in‐field failure for nasopharyngeal carcinoma after intensity‐modulated radiotherapy

Liu

Huang

et al. 2022

Head & Neck

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Background To identify the tumor factors of in‐field failure for nasopharyngeal carcinoma (NPC) in the intensity‐modulated radiotherapy (IMRT) era. Methods Patterns of recurrence were classified as in‐field, marginal, and out‐field failures. Multivariate analyses with the Cox proportional hazards model were used to identify tumor‐related factors of in‐field failure. Results A total of 1039 patients with NPC received IMRT from 2012 to 2019 and 75 developed recurrences, with 88.0% (66/75) considered as having in‐field failures. Multivariate analysis showed that pretreatment gross tumor volume of nasopharynx ≥68.8 mL and histopathological type of nonkeratinizing differentiated carcinoma (NKDC) were the independent tumor factors of in‐field local failure, while gross tumor volume of involved lymph nodes ≥19.9 mL and cervical nodal necrosis (CNN) were associated with in‐field regional failure (all p < 0.05). Conclusions In‐field failure was the major pattern of recurrence in patients with NPC. Large tumor volume, NKDC, and CNN were the tumor factors associated with in‐field failure.

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“…These studies have gone further to investigate the prognostic values of nodal characteristics in detail [42][43][44][45][46]. Necrosis is easily observed in metastatic nodes from NPC but very rarely in primary tumour (about 2%) on the pre-treatment staging MRI [34].…”

Section: Discussionmentioning

confidence: 99%

“…Eighteen studies were subsequently excluded due to the speci c reasons (Table 1) [9-18, 32-39], leaving 9 studies for the further systematic review and analysis [19][20][21][22][23][24][25][26][27]. CNN + necrotic primary tumour as one variable was assessed 1 [34] Studies conducted by the same institution with overlapping patient recruitment periods and analysis performed for the same CNN pattern 5 [35][36][37][38][39] IMRT = intensity-modulated radiotherapy, DMFS =distant metastases free survival, HR =hazard ratio, CNN = cervical nodal necrosis…”

Section: Study Selectionmentioning

confidence: 99%

Prognostic value of cervical nodal necrosis on staging imaging of nasopharyngeal carcinoma in era of intensity-modulated radiotherapy: A systematic review and meta-analysis

Hung

et al. 2022

Preprint

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Purposes To systematically review and perform meta-analysis to evaluate the prognostic value of cervical nodal necrosis (CNN) on the staging computed tomography/magnetic resonance imaging (MRI) of nasopharyngeal carcinoma (NPC) in era of intensity-modulated radiotherapy. Methods Literature search through PubMed, EMBASE, and Cochrane Library was conducted. The hazard ratios (HRs) with 95% confidence intervals (CIs) of CNN for distant metastasis-free survival (DMFS), disease free survival (DFS) and overall survival (OS) were extracted from the eligible studies and meta-analysis was performed to evaluate the pooled HRs with 95%CI. Results Nine studies, which investigated the prognostic values of 6 CNN patterns on MRI were included. Six/9 studies were eligible for meta-analysis, which investigated the CNN presence/absence in any nodal group among 4359 patients. The pooled unadjusted HRs showed that the CNN presence predicted poor DMFS (HR =1.89, 95%CI =1.72-2.08), DFS (HR =1.57, 95%CI =1.08-2.26), and OS (HR =1.87, 95%CI =1.69-2.06). The pooled adjusted HRs also showed the consistent results for DMFS (HR =1.34, 95%CI =1.17-1.54), DFS (HR =1.30, 95%CI =1.08-1.56), and OS (HR =1.61, 95%CI =1.27-2.04). Results shown in the other studies analysing different CNN patterns indicated the high grade of CNN predicted poor outcome, but meta-analysis was unable to perform because the heterogeneity of the analysed CNN patterns. Conclusion The CNN observed on the staging MRI is a negative factor for NPC outcome, suggesting that the inclusion of CNN is important in the future survival analysis. However, whether and how should CNN be included in the staging system warrant further evaluation.

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Influence of tumor necrosis on treatment sensitivity and long-term survival in nasopharyngeal carcinoma

Cited by 26 publications

References 27 publications

Prognostic value of cervical nodal necrosis on staging imaging of nasopharyngeal carcinoma in era of intensity-modulated radiotherapy: a systematic review and meta-analysis

Prognostic value of cervical nodal necrosis on staging imaging of nasopharyngeal carcinoma in era of intensity-modulated radiotherapy: a systematic review and meta-analysis

Tumor factors associated with in‐field failure for nasopharyngeal carcinoma after intensity‐modulated radiotherapy

Prognostic value of cervical nodal necrosis on staging imaging of nasopharyngeal carcinoma in era of intensity-modulated radiotherapy: A systematic review and meta-analysis

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