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Quantitative Metastatic Lymph Node Regions on Magnetic Resonance Imaging Are Superior to AJCC N Classification for the Prognosis of Nasopharyngeal Carcinoma
PURPOSE: Quantitative lymph node burden has been demonstrated to be a critical prognosticator in various malignancies, yet it was seldom explored in nasopharyngeal carcinoma (NPC). This study aimed to investigate the impact of the number of metastatic lymph node regions (LRN) on prognosis of NPC and...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304546/ https://www.ncbi.nlm.nih.gov/pubmed/30631357 http://dx.doi.org/10.1155/2018/9172585 |
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author | Zhou, Xin Ou, Xiaomin Yang, Youqi Xu, Tingting Shen, Chunying Ding, Jianhui Hu, Chaosu |
author_facet | Zhou, Xin Ou, Xiaomin Yang, Youqi Xu, Tingting Shen, Chunying Ding, Jianhui Hu, Chaosu |
author_sort | Zhou, Xin |
collection | PubMed |
description | PURPOSE: Quantitative lymph node burden has been demonstrated to be a critical prognosticator in various malignancies, yet it was seldom explored in nasopharyngeal carcinoma (NPC). This study aimed to investigate the impact of the number of metastatic lymph node regions (LRN) on prognosis of NPC and to establish a new N classification system based on LRN. METHODS AND MATERIALS: The magnetic resonance images (MRI) of 354 nondisseminated NPC patients before radical treatment were retrospectively evaluated. The regions with positive lymph nodes (LNs) were quantified according to 2013 updated guidelines for neck node levels. Prognostic value of LRN on distant metastasis-free survival (DMFS) was analyzed using multivariable Cox model after adjusting for other nodal characteristics and therapeutic factors. RESULTS: LRN strongly correlated with the size, laterality, level, extracapsular extension (ECE), and necrosis of LNs. Risk of distant metastasis significantly escalated with increased LRN (P<0.001). 5-year DMFS for LRN 0-1, 2-6, and ⩾7 was 97.0%, 86.7%, and 69.7%, respectively. In multivariable Cox analysis, LRN (HR 2.45; 95% CI 1.55-3.88; P<0.001) and maximal LN diameter (MLD) >6cm (HR 4.11; 95% CI 2.23-7.56; P<0.001) were identified as independent predictors of DMFS. Laterality and level showed no prognostic significance when accounting for LRN. A novel N classification scheme was derived by recursive partitioning analysis based on LRN and MLD. Compared with the 7th and 8th edition of American Joint Committee on Cancer (AJCC) systems, the new stratification exhibited better accuracy in predicting survivals. CONCLUSIONS: LRN is a promising quantitative predictor of survival in NPC, eclipsing other classic LN characteristics in prognostic value. The simplified N classification scheme with LRN and MLD is predictive and practical, thus warranting further validation in future. |
format | Online Article Text |
id | pubmed-6304546 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-63045462019-01-10 Quantitative Metastatic Lymph Node Regions on Magnetic Resonance Imaging Are Superior to AJCC N Classification for the Prognosis of Nasopharyngeal Carcinoma Zhou, Xin Ou, Xiaomin Yang, Youqi Xu, Tingting Shen, Chunying Ding, Jianhui Hu, Chaosu J Oncol Research Article PURPOSE: Quantitative lymph node burden has been demonstrated to be a critical prognosticator in various malignancies, yet it was seldom explored in nasopharyngeal carcinoma (NPC). This study aimed to investigate the impact of the number of metastatic lymph node regions (LRN) on prognosis of NPC and to establish a new N classification system based on LRN. METHODS AND MATERIALS: The magnetic resonance images (MRI) of 354 nondisseminated NPC patients before radical treatment were retrospectively evaluated. The regions with positive lymph nodes (LNs) were quantified according to 2013 updated guidelines for neck node levels. Prognostic value of LRN on distant metastasis-free survival (DMFS) was analyzed using multivariable Cox model after adjusting for other nodal characteristics and therapeutic factors. RESULTS: LRN strongly correlated with the size, laterality, level, extracapsular extension (ECE), and necrosis of LNs. Risk of distant metastasis significantly escalated with increased LRN (P<0.001). 5-year DMFS for LRN 0-1, 2-6, and ⩾7 was 97.0%, 86.7%, and 69.7%, respectively. In multivariable Cox analysis, LRN (HR 2.45; 95% CI 1.55-3.88; P<0.001) and maximal LN diameter (MLD) >6cm (HR 4.11; 95% CI 2.23-7.56; P<0.001) were identified as independent predictors of DMFS. Laterality and level showed no prognostic significance when accounting for LRN. A novel N classification scheme was derived by recursive partitioning analysis based on LRN and MLD. Compared with the 7th and 8th edition of American Joint Committee on Cancer (AJCC) systems, the new stratification exhibited better accuracy in predicting survivals. CONCLUSIONS: LRN is a promising quantitative predictor of survival in NPC, eclipsing other classic LN characteristics in prognostic value. The simplified N classification scheme with LRN and MLD is predictive and practical, thus warranting further validation in future. Hindawi 2018-12-02 /pmc/articles/PMC6304546/ /pubmed/30631357 http://dx.doi.org/10.1155/2018/9172585 Text en Copyright © 2018 Xin Zhou et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Zhou, Xin Ou, Xiaomin Yang, Youqi Xu, Tingting Shen, Chunying Ding, Jianhui Hu, Chaosu Quantitative Metastatic Lymph Node Regions on Magnetic Resonance Imaging Are Superior to AJCC N Classification for the Prognosis of Nasopharyngeal Carcinoma |
title | Quantitative Metastatic Lymph Node Regions on Magnetic Resonance Imaging Are Superior to AJCC N Classification for the Prognosis of Nasopharyngeal Carcinoma |
title_full | Quantitative Metastatic Lymph Node Regions on Magnetic Resonance Imaging Are Superior to AJCC N Classification for the Prognosis of Nasopharyngeal Carcinoma |
title_fullStr | Quantitative Metastatic Lymph Node Regions on Magnetic Resonance Imaging Are Superior to AJCC N Classification for the Prognosis of Nasopharyngeal Carcinoma |
title_full_unstemmed | Quantitative Metastatic Lymph Node Regions on Magnetic Resonance Imaging Are Superior to AJCC N Classification for the Prognosis of Nasopharyngeal Carcinoma |
title_short | Quantitative Metastatic Lymph Node Regions on Magnetic Resonance Imaging Are Superior to AJCC N Classification for the Prognosis of Nasopharyngeal Carcinoma |
title_sort | quantitative metastatic lymph node regions on magnetic resonance imaging are superior to ajcc n classification for the prognosis of nasopharyngeal carcinoma |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304546/ https://www.ncbi.nlm.nih.gov/pubmed/30631357 http://dx.doi.org/10.1155/2018/9172585 |
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