Prognostic significance of quantitative metastatic lymph node burden on magnetic resonance imaging in nasopharyngeal carcinoma: A retrospective study of 1224 patients from two centers

Ma, Huali; Liang, Shuli; Cui, Chunyan; Zhong, Yu; Xie, Fei; Zhou, Jian; Dong, Annan; Chen, Ming‐Yuan; Xie, Chuanbo; Li, Haojiang; Liu, Lizhi

doi:10.1016/j.radonc.2020.07.023

Cited by 27 publications

(36 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[12][13][14][15][16] The number of MRIpositive lymph nodes has been reported to be a predominant independent prognostic factor for survival in NPC patients and is a better proxy for the cumulative effect of lymph nodes than AJCC N staging. 22 Additionall y, quantitative metastatic lymph node regions were shown to be superior to N classification in terms of prognosis in NPC. 23 In addition, high-grade extranodal extension was reported as an evaluable predictor that could assist in the selection of stage II patients with a high risk of distant metastases.…”

Section: Discussionmentioning

confidence: 97%

“…[17][18][19] Furthermore, the burden-related lymph node features, such as volume and number of positive lymph nodes (PLNs), and number of positive lymph node regions, are proved prognostic factors for NPC progression. [20][21][22][23] However, to the best of our knowledge, no comprehensive lymph node feature-based prognosis stratification and concurrent chemotherapy decision-making protocol has been reported for patients with stage II NPC.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

MRI-identified multidimensional nodal features predict survival and concurrent chemotherapy benefit for stage II nasopharyngeal carcinoma

Liu

Zhang

Wang

et al. 2022

Radiology and Oncology

View full text Add to dashboard Cite

Background Reliable predictors are urgently needed to identify stage II nasopharyngeal carcinoma (NPC) patients who could benefit from concurrent chemoradiotherapy (CCRT). We aimed to develop a nomogram integrating MRI-identified multidimensional features of lymph nodes to predict survival and assist the decision-making of CCRT for stage II NPC. Patients and methods This retrospective study enrolled 242 stage II NPC patients treated from January 2007 to December 2017. Overall survival (OS) was the primary endpoint. Performance of nomogram was evaluated using calibration curves, Harrell Concordance Index (C-index), area under the curve (AUC) and decision curves analysis (DCA) and was compared with TNM staging. According to the individualized nomogram score, patients were classified into two risk cohorts and therapeutic efficacy of CCRT were evaluated in each cohort. Results Three independent prognostic factors for OS: age, number and location of positive lymph nodes were included into the final nomogram. T stage was also incorporated due to its importance in clinical decision-making. Calibration plots demonstrated a good match between the predicted and our observed OS rates. C-index for nomogram was 0.726 compared with 0.537 for TNM staging (p < 0.001). DCAs confirmed the superior clinical utility of nomograms compared with TNM staging. CCRT compared to intensity-modulated radiotherapy (IMRT) delivered OS benefit to patients in the high-risk group (5-year: 89.9% vs. 72.1%; 10-year: 72.5% vs. 34.2%, p = 0.011), but not in the low-risk group. Conclusions This lymph node features-based nomogram demonstrated excellent discrimination and predictive accuracy for stage II patients and could identify patients who can benefit from CCRT.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

MRI-identified multidimensional nodal features predict survival and concurrent chemotherapy benefit for stage II nasopharyngeal carcinoma

Liu

Zhang

Wang

et al. 2022

Radiology and Oncology

View full text Add to dashboard Cite

show abstract

“…Nasopharyngeal carcinoma is one of head and neck tumors with a high rate of lymph node involvement [14][15][16]. Approximately 85% of the NPC patients were con rmed as having lymph node metastasis [7,17].…”

Section: Discussionmentioning

confidence: 99%

The proposal of boundary setting for the posterior to level V region and the theoretical feasibility of prophylactic irradiation dose reduction of level Va in nasopharyngeal carcinoma: A retrospective study in a single-center

Jiang¹,

Li²,

Zhang³

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: The lymph node involvement in the posterior to level V (PLV) region is mainly observed in nasopharyngeal carcinoma (NPC). Recently, we have reported the distribution of metastatic lymph nodes in the PLV region and there are correlations between the neck node levels (NNL) of NPC, but what is the boundary of the PLV region and how to delineate it remains unclear, and we further to elaborate whether the bilateral level Va should be covered as intermediate-risk clinical target volumes (CTVn2, about 60 Gy equivalent) for all T and N categories based on these correlations.Methods: A total of 1021 consecutive NPC patients with N1-3 stage from January 2012 to December 2020 were reviewed. The lymph node metastasis level of each patient was evaluated according to the updated guidelines proposed in 2013. According to the distribution pattern of lymph node metastasis and the anatomical structure in the PLV region, the boundaries of PLV region was delineated, and whether it is appropriate to cover the bilateral level Va as CTVn2 for all the NPC patients was further discussed.Results: The cranial boundary of PLV region is the caudal border of cricoid cartilage, the caudal boundary is the plane serratus anterior muscle begins to appear, the anterior boundary is the anterior border of trapezius, and the posterior boundary is the convergence of levator scapulae and trapezius. Laterally, the PLV region is limited by the medial edge of trapezius and medially by the lateral surface of levator scapulae. The nodal spread in level Va is based on the lymph node metastasis of level IIb in NPC.Conclusions: The PLV region is a missing NNL of head and neck tumors, especially in NPC. The proposed boundaries of the PLV region can provide a preliminary proposal for the further revision of NNL in head and neck tumors. It is theoretically feasible to reduce the prophylactic irradiation dose of the bilateral level Va in patients with N0 stage or with isolated metastases in level VIIa.

show abstract

Section: Discussionmentioning

confidence: 99%

The proposal of boundary setting for the posterior to level V region and the theoretical feasibility of prophylactic irradiation dose reduction of level Va in nasopharyngeal carcinoma: A retrospective study in a single-center

Jiang¹,

Li²,

Zhang³

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: The lymph node involvement in the posterior to level V (PLV) region is mainly observed in nasopharyngeal carcinoma (NPC). Recently, we have reported the distribution of metastatic lymph nodes in the PLV region and there are correlations between the neck node levels (NNL) of NPC, but what is the boundary of the PLV region and how to delineate it remains unclear, and we further to elaborate whether the bilateral level Va should be covered as intermediate-risk clinical target volumes (CTVn2, about 60 Gy equivalent) for all T and N categories based on these correlations. Methods: A total of 1021 consecutive NPC patients with N1-3 stage from January 2012 to December 2020 were reviewed. The lymph node metastasis level of each patient was evaluated according to the updated guidelines proposed in 2013. According to the distribution pattern of lymph node metastasis and the anatomical structure in the PLV region, the boundaries of PLV region was delineated, and whether it is appropriate to cover the bilateral level Va as CTVn2 for all the NPC patients was further discussed. Results: The cranial boundary of PLV region is the caudal border of cricoid cartilage, the caudal boundary is the plane serratus anterior muscle begins to appear, the anterior boundary is the anterior border of trapezius, and the posterior boundary is the convergence of levator scapulae and trapezius. Laterally, the PLV region is limited by the medial edge of trapezius and medially by the lateral surface of levator scapulae. The nodal spread in level Va is based on the lymph node metastasis of level IIb in NPC. Conclusions: The PLV region is a missing NNL of head and neck tumors, especially in NPC. The proposed boundaries of the PLV region can provide a preliminary proposal for the further revision of NNL in head and neck tumors. It is theoretically feasible to reduce the prophylactic irradiation dose of the bilateral level Va in patients with N0 stage or with isolated metastases in level VIIa.

show abstract

Prognostic significance of quantitative metastatic lymph node burden on magnetic resonance imaging in nasopharyngeal carcinoma: A retrospective study of 1224 patients from two centers

Cited by 27 publications

References 20 publications

MRI-identified multidimensional nodal features predict survival and concurrent chemotherapy benefit for stage II nasopharyngeal carcinoma

MRI-identified multidimensional nodal features predict survival and concurrent chemotherapy benefit for stage II nasopharyngeal carcinoma

The proposal of boundary setting for the posterior to level V region and the theoretical feasibility of prophylactic irradiation dose reduction of level Va in nasopharyngeal carcinoma: A retrospective study in a single-center

The proposal of boundary setting for the posterior to level V region and the theoretical feasibility of prophylactic irradiation dose reduction of level Va in nasopharyngeal carcinoma: A retrospective study in a single-center

Contact Info

Product

Resources

About