Nodal grouping in nasopharyngeal carcinoma: prognostic significance, N classification, and a marker for the identification of candidates for induction chemotherapy
Objectives This study aimed to evaluate the value of nodal grouping (NG), defined as the presence of at least three contiguous lymph nodes (LNs) within one LN region, in staging and management of patients with non-metastatic nasopharyngeal carcinoma (NPC). Methods MR images were reviewed to evaluate...
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| Veröffentlicht in: | European radiology 2020-04, Vol.30 (4), p.2115-2124 |
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| creator | Liu, Yifei Chen, Shenghuan Dong, Annan Ai, Fei Quan, Tingting Cui, Chunyan Zhou, Jian Liang, Shaobo Wang, Jiamin Wang, Shunxin Hua, Ling Xu, Shuoyu Chen, Mingyuan Sun, Ying Li, Haojiang Liu, Lizhi |
| description | Objectives
This study aimed to evaluate the value of nodal grouping (NG), defined as the presence of at least three contiguous lymph nodes (LNs) within one LN region, in staging and management of patients with non-metastatic nasopharyngeal carcinoma (NPC).
Methods
MR images were reviewed to evaluate LN variables, including NG. The Kaplan–Meier method and multivariate Cox regression models evaluated the association between the variables and survival. Harrell’s concordance index (C-index) was used to measure the performance of prognostic models. The outcome of induction chemotherapy (IC) in patients with and without NG was compared using matched-pair analysis.
Results
In 1224 patients enrolled, NG was found to be an independent prognostic factor for overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and regional recurrence-free survival. The hazard ratio and 95% confidence interval (CI) of NG for OS (3.86, 2.09–7.12) were higher than those of stage N2 (3.54, 1.89–6.70). On upgrading patients with NG from stages N1 to N2, the revised N staging yielded a higher C-index compared to the American Joint Committee on Cancer system in predicting PFS (0.664 vs. 0.658,
p
= 0.022) and DMFS (0.699 vs. 0.690,
p
= 0.005). Results of the matched-pair analysis revealed that for patients with NG in stages N1 and N2, IC was correlated with improved OS (
p
= 0.022), PFS (
p
= 0.007), and DMFS (
p
= 0.021).
Conclusions
NG is a significant prognostic factor for patients with NPC. Patients with NG may be upgraded from stages N1 to N2. NG was also a marker for identifying patients who would benefit from IC.
Key Points
•
Nodal grouping, defined as the presence of at least three contiguous LNs within one LN region on MRI, was identified as a significant prognostic factor.
•
In patients with nasopharyngeal carcinoma, nodal grouping may influence lymph node staging.
•
Nodal grouping was a marker for identifying patients who may benefit from induction chemotherapy. |
| doi_str_mv | 10.1007/s00330-019-06537-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2375288358</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2375288358</sourcerecordid><originalsourceid>FETCH-LOGICAL-c408t-d50a42cc528a0700863ab0938116e173418c10e7f9cd4c71daa060d0241c95783</originalsourceid><addsrcrecordid>eNp9kc1O3DAUhS3UCgbaF-iistQtodexEzvsKsSfhOgG1tbFdjKmM3awk8U8Dy-KZ4bSXVeWfL5zru49hHxjcMYA5M8MwDlUwLoK2obLqj0gCyZ4XTFQ4hNZQMdVJbtOHJHjnJ8BoGNCHpIjzhRjou4W5PU-WlzRIcV59GGgPtCAOY5LTJswuCIZTMaHuMZzOqY4hJgnb2j2Q_C9NxiMO6X31Kww593H5GM4pRgsRbrG9Mcl2sdEp6Wj3rowfUA09iU8WG9xcnkH-WBns9PM0q1j8SQcN1_I5x5X2X19f0_I49Xlw8VNdff7-vbi111lBKipsg2gqI1paoUgAVTL8Wl7AsZaxyQXTBkGTvadscJIZhGhBQu1YKZrpOIn5Mc-t-z5Mrs86ec4p1BG6prLEqt4s6XqPWVSzDm5Xo_Jl0U3moHe9qL3vejSi971otti-v4ePT-tnf2w_C2iAHwP5CKVw6d_s_8T-wbi7ZsV</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2375288358</pqid></control><display><type>article</type><title>Nodal grouping in nasopharyngeal carcinoma: prognostic significance, N classification, and a marker for the identification of candidates for induction chemotherapy</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Liu, Yifei ; Chen, Shenghuan ; Dong, Annan ; Ai, Fei ; Quan, Tingting ; Cui, Chunyan ; Zhou, Jian ; Liang, Shaobo ; Wang, Jiamin ; Wang, Shunxin ; Hua, Ling ; Xu, Shuoyu ; Chen, Mingyuan ; Sun, Ying ; Li, Haojiang ; Liu, Lizhi</creator><creatorcontrib>Liu, Yifei ; Chen, Shenghuan ; Dong, Annan ; Ai, Fei ; Quan, Tingting ; Cui, Chunyan ; Zhou, Jian ; Liang, Shaobo ; Wang, Jiamin ; Wang, Shunxin ; Hua, Ling ; Xu, Shuoyu ; Chen, Mingyuan ; Sun, Ying ; Li, Haojiang ; Liu, Lizhi</creatorcontrib><description>Objectives
This study aimed to evaluate the value of nodal grouping (NG), defined as the presence of at least three contiguous lymph nodes (LNs) within one LN region, in staging and management of patients with non-metastatic nasopharyngeal carcinoma (NPC).
Methods
MR images were reviewed to evaluate LN variables, including NG. The Kaplan–Meier method and multivariate Cox regression models evaluated the association between the variables and survival. Harrell’s concordance index (C-index) was used to measure the performance of prognostic models. The outcome of induction chemotherapy (IC) in patients with and without NG was compared using matched-pair analysis.
Results
In 1224 patients enrolled, NG was found to be an independent prognostic factor for overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and regional recurrence-free survival. The hazard ratio and 95% confidence interval (CI) of NG for OS (3.86, 2.09–7.12) were higher than those of stage N2 (3.54, 1.89–6.70). On upgrading patients with NG from stages N1 to N2, the revised N staging yielded a higher C-index compared to the American Joint Committee on Cancer system in predicting PFS (0.664 vs. 0.658,
p
= 0.022) and DMFS (0.699 vs. 0.690,
p
= 0.005). Results of the matched-pair analysis revealed that for patients with NG in stages N1 and N2, IC was correlated with improved OS (
p
= 0.022), PFS (
p
= 0.007), and DMFS (
p
= 0.021).
Conclusions
NG is a significant prognostic factor for patients with NPC. Patients with NG may be upgraded from stages N1 to N2. NG was also a marker for identifying patients who would benefit from IC.
Key Points
•
Nodal grouping, defined as the presence of at least three contiguous LNs within one LN region on MRI, was identified as a significant prognostic factor.
•
In patients with nasopharyngeal carcinoma, nodal grouping may influence lymph node staging.
•
Nodal grouping was a marker for identifying patients who may benefit from induction chemotherapy.</description><identifier>ISSN: 0938-7994</identifier><identifier>EISSN: 1432-1084</identifier><identifier>DOI: 10.1007/s00330-019-06537-6</identifier><identifier>PMID: 31811429</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Cancer ; Chemotherapy ; Confidence intervals ; Diagnostic Radiology ; Female ; Head and Neck ; Humans ; Imaging ; Induction Chemotherapy - methods ; Internal Medicine ; Interventional Radiology ; Lymph nodes ; Lymph Nodes - pathology ; Lymphatic Metastasis ; Magnetic resonance imaging ; Magnetic Resonance Imaging - methods ; Male ; Markers ; Medical prognosis ; Medicine ; Medicine & Public Health ; Metastases ; Middle Aged ; Nasopharyngeal carcinoma ; Nasopharyngeal Carcinoma - classification ; Nasopharyngeal Carcinoma - drug therapy ; Nasopharyngeal Carcinoma - secondary ; Nasopharyngeal Neoplasms - classification ; Nasopharyngeal Neoplasms - diagnosis ; Nasopharyngeal Neoplasms - drug therapy ; Neoplasm Staging ; Neuroradiology ; Prognosis ; Progression-Free Survival ; Radiology ; Regression analysis ; Regression models ; Retrospective Studies ; Statistical analysis ; Survival ; Throat cancer ; Ultrasound</subject><ispartof>European radiology, 2020-04, Vol.30 (4), p.2115-2124</ispartof><rights>European Society of Radiology 2019</rights><rights>European Radiology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-d50a42cc528a0700863ab0938116e173418c10e7f9cd4c71daa060d0241c95783</citedby><cites>FETCH-LOGICAL-c408t-d50a42cc528a0700863ab0938116e173418c10e7f9cd4c71daa060d0241c95783</cites><orcidid>0000-0002-3977-0518</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00330-019-06537-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00330-019-06537-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31811429$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liu, Yifei</creatorcontrib><creatorcontrib>Chen, Shenghuan</creatorcontrib><creatorcontrib>Dong, Annan</creatorcontrib><creatorcontrib>Ai, Fei</creatorcontrib><creatorcontrib>Quan, Tingting</creatorcontrib><creatorcontrib>Cui, Chunyan</creatorcontrib><creatorcontrib>Zhou, Jian</creatorcontrib><creatorcontrib>Liang, Shaobo</creatorcontrib><creatorcontrib>Wang, Jiamin</creatorcontrib><creatorcontrib>Wang, Shunxin</creatorcontrib><creatorcontrib>Hua, Ling</creatorcontrib><creatorcontrib>Xu, Shuoyu</creatorcontrib><creatorcontrib>Chen, Mingyuan</creatorcontrib><creatorcontrib>Sun, Ying</creatorcontrib><creatorcontrib>Li, Haojiang</creatorcontrib><creatorcontrib>Liu, Lizhi</creatorcontrib><title>Nodal grouping in nasopharyngeal carcinoma: prognostic significance, N classification, and a marker for the identification of candidates for induction chemotherapy</title><title>European radiology</title><addtitle>Eur Radiol</addtitle><addtitle>Eur Radiol</addtitle><description>Objectives
This study aimed to evaluate the value of nodal grouping (NG), defined as the presence of at least three contiguous lymph nodes (LNs) within one LN region, in staging and management of patients with non-metastatic nasopharyngeal carcinoma (NPC).
Methods
MR images were reviewed to evaluate LN variables, including NG. The Kaplan–Meier method and multivariate Cox regression models evaluated the association between the variables and survival. Harrell’s concordance index (C-index) was used to measure the performance of prognostic models. The outcome of induction chemotherapy (IC) in patients with and without NG was compared using matched-pair analysis.
Results
In 1224 patients enrolled, NG was found to be an independent prognostic factor for overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and regional recurrence-free survival. The hazard ratio and 95% confidence interval (CI) of NG for OS (3.86, 2.09–7.12) were higher than those of stage N2 (3.54, 1.89–6.70). On upgrading patients with NG from stages N1 to N2, the revised N staging yielded a higher C-index compared to the American Joint Committee on Cancer system in predicting PFS (0.664 vs. 0.658,
p
= 0.022) and DMFS (0.699 vs. 0.690,
p
= 0.005). Results of the matched-pair analysis revealed that for patients with NG in stages N1 and N2, IC was correlated with improved OS (
p
= 0.022), PFS (
p
= 0.007), and DMFS (
p
= 0.021).
Conclusions
NG is a significant prognostic factor for patients with NPC. Patients with NG may be upgraded from stages N1 to N2. NG was also a marker for identifying patients who would benefit from IC.
Key Points
•
Nodal grouping, defined as the presence of at least three contiguous LNs within one LN region on MRI, was identified as a significant prognostic factor.
•
In patients with nasopharyngeal carcinoma, nodal grouping may influence lymph node staging.
•
Nodal grouping was a marker for identifying patients who may benefit from induction chemotherapy.</description><subject>Adult</subject><subject>Cancer</subject><subject>Chemotherapy</subject><subject>Confidence intervals</subject><subject>Diagnostic Radiology</subject><subject>Female</subject><subject>Head and Neck</subject><subject>Humans</subject><subject>Imaging</subject><subject>Induction Chemotherapy - methods</subject><subject>Internal Medicine</subject><subject>Interventional Radiology</subject><subject>Lymph nodes</subject><subject>Lymph Nodes - pathology</subject><subject>Lymphatic Metastasis</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Markers</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Middle Aged</subject><subject>Nasopharyngeal carcinoma</subject><subject>Nasopharyngeal Carcinoma - classification</subject><subject>Nasopharyngeal Carcinoma - drug therapy</subject><subject>Nasopharyngeal Carcinoma - secondary</subject><subject>Nasopharyngeal Neoplasms - classification</subject><subject>Nasopharyngeal Neoplasms - diagnosis</subject><subject>Nasopharyngeal Neoplasms - drug therapy</subject><subject>Neoplasm Staging</subject><subject>Neuroradiology</subject><subject>Prognosis</subject><subject>Progression-Free Survival</subject><subject>Radiology</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Retrospective Studies</subject><subject>Statistical analysis</subject><subject>Survival</subject><subject>Throat cancer</subject><subject>Ultrasound</subject><issn>0938-7994</issn><issn>1432-1084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kc1O3DAUhS3UCgbaF-iistQtodexEzvsKsSfhOgG1tbFdjKmM3awk8U8Dy-KZ4bSXVeWfL5zru49hHxjcMYA5M8MwDlUwLoK2obLqj0gCyZ4XTFQ4hNZQMdVJbtOHJHjnJ8BoGNCHpIjzhRjou4W5PU-WlzRIcV59GGgPtCAOY5LTJswuCIZTMaHuMZzOqY4hJgnb2j2Q_C9NxiMO6X31Kww593H5GM4pRgsRbrG9Mcl2sdEp6Wj3rowfUA09iU8WG9xcnkH-WBns9PM0q1j8SQcN1_I5x5X2X19f0_I49Xlw8VNdff7-vbi111lBKipsg2gqI1paoUgAVTL8Wl7AsZaxyQXTBkGTvadscJIZhGhBQu1YKZrpOIn5Mc-t-z5Mrs86ec4p1BG6prLEqt4s6XqPWVSzDm5Xo_Jl0U3moHe9qL3vejSi971otti-v4ePT-tnf2w_C2iAHwP5CKVw6d_s_8T-wbi7ZsV</recordid><startdate>20200401</startdate><enddate>20200401</enddate><creator>Liu, Yifei</creator><creator>Chen, Shenghuan</creator><creator>Dong, Annan</creator><creator>Ai, Fei</creator><creator>Quan, Tingting</creator><creator>Cui, Chunyan</creator><creator>Zhou, Jian</creator><creator>Liang, Shaobo</creator><creator>Wang, Jiamin</creator><creator>Wang, Shunxin</creator><creator>Hua, Ling</creator><creator>Xu, Shuoyu</creator><creator>Chen, Mingyuan</creator><creator>Sun, Ying</creator><creator>Li, Haojiang</creator><creator>Liu, Lizhi</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><orcidid>https://orcid.org/0000-0002-3977-0518</orcidid></search><sort><creationdate>20200401</creationdate><title>Nodal grouping in nasopharyngeal carcinoma: prognostic significance, N classification, and a marker for the identification of candidates for induction chemotherapy</title><author>Liu, Yifei ; Chen, Shenghuan ; Dong, Annan ; Ai, Fei ; Quan, Tingting ; Cui, Chunyan ; Zhou, Jian ; Liang, Shaobo ; Wang, Jiamin ; Wang, Shunxin ; Hua, Ling ; Xu, Shuoyu ; Chen, Mingyuan ; Sun, Ying ; Li, Haojiang ; Liu, Lizhi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-d50a42cc528a0700863ab0938116e173418c10e7f9cd4c71daa060d0241c95783</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Cancer</topic><topic>Chemotherapy</topic><topic>Confidence intervals</topic><topic>Diagnostic Radiology</topic><topic>Female</topic><topic>Head and Neck</topic><topic>Humans</topic><topic>Imaging</topic><topic>Induction Chemotherapy - methods</topic><topic>Internal Medicine</topic><topic>Interventional Radiology</topic><topic>Lymph nodes</topic><topic>Lymph Nodes - pathology</topic><topic>Lymphatic Metastasis</topic><topic>Magnetic resonance imaging</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Markers</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Middle Aged</topic><topic>Nasopharyngeal carcinoma</topic><topic>Nasopharyngeal Carcinoma - classification</topic><topic>Nasopharyngeal Carcinoma - drug therapy</topic><topic>Nasopharyngeal Carcinoma - secondary</topic><topic>Nasopharyngeal Neoplasms - classification</topic><topic>Nasopharyngeal Neoplasms - diagnosis</topic><topic>Nasopharyngeal Neoplasms - drug therapy</topic><topic>Neoplasm Staging</topic><topic>Neuroradiology</topic><topic>Prognosis</topic><topic>Progression-Free Survival</topic><topic>Radiology</topic><topic>Regression analysis</topic><topic>Regression models</topic><topic>Retrospective Studies</topic><topic>Statistical analysis</topic><topic>Survival</topic><topic>Throat cancer</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liu, Yifei</creatorcontrib><creatorcontrib>Chen, Shenghuan</creatorcontrib><creatorcontrib>Dong, Annan</creatorcontrib><creatorcontrib>Ai, Fei</creatorcontrib><creatorcontrib>Quan, Tingting</creatorcontrib><creatorcontrib>Cui, Chunyan</creatorcontrib><creatorcontrib>Zhou, Jian</creatorcontrib><creatorcontrib>Liang, Shaobo</creatorcontrib><creatorcontrib>Wang, Jiamin</creatorcontrib><creatorcontrib>Wang, Shunxin</creatorcontrib><creatorcontrib>Hua, Ling</creatorcontrib><creatorcontrib>Xu, Shuoyu</creatorcontrib><creatorcontrib>Chen, Mingyuan</creatorcontrib><creatorcontrib>Sun, Ying</creatorcontrib><creatorcontrib>Li, Haojiang</creatorcontrib><creatorcontrib>Liu, Lizhi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><jtitle>European radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liu, Yifei</au><au>Chen, Shenghuan</au><au>Dong, Annan</au><au>Ai, Fei</au><au>Quan, Tingting</au><au>Cui, Chunyan</au><au>Zhou, Jian</au><au>Liang, Shaobo</au><au>Wang, Jiamin</au><au>Wang, Shunxin</au><au>Hua, Ling</au><au>Xu, Shuoyu</au><au>Chen, Mingyuan</au><au>Sun, Ying</au><au>Li, Haojiang</au><au>Liu, Lizhi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nodal grouping in nasopharyngeal carcinoma: prognostic significance, N classification, and a marker for the identification of candidates for induction chemotherapy</atitle><jtitle>European radiology</jtitle><stitle>Eur Radiol</stitle><addtitle>Eur Radiol</addtitle><date>2020-04-01</date><risdate>2020</risdate><volume>30</volume><issue>4</issue><spage>2115</spage><epage>2124</epage><pages>2115-2124</pages><issn>0938-7994</issn><eissn>1432-1084</eissn><abstract>Objectives
This study aimed to evaluate the value of nodal grouping (NG), defined as the presence of at least three contiguous lymph nodes (LNs) within one LN region, in staging and management of patients with non-metastatic nasopharyngeal carcinoma (NPC).
Methods
MR images were reviewed to evaluate LN variables, including NG. The Kaplan–Meier method and multivariate Cox regression models evaluated the association between the variables and survival. Harrell’s concordance index (C-index) was used to measure the performance of prognostic models. The outcome of induction chemotherapy (IC) in patients with and without NG was compared using matched-pair analysis.
Results
In 1224 patients enrolled, NG was found to be an independent prognostic factor for overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and regional recurrence-free survival. The hazard ratio and 95% confidence interval (CI) of NG for OS (3.86, 2.09–7.12) were higher than those of stage N2 (3.54, 1.89–6.70). On upgrading patients with NG from stages N1 to N2, the revised N staging yielded a higher C-index compared to the American Joint Committee on Cancer system in predicting PFS (0.664 vs. 0.658,
p
= 0.022) and DMFS (0.699 vs. 0.690,
p
= 0.005). Results of the matched-pair analysis revealed that for patients with NG in stages N1 and N2, IC was correlated with improved OS (
p
= 0.022), PFS (
p
= 0.007), and DMFS (
p
= 0.021).
Conclusions
NG is a significant prognostic factor for patients with NPC. Patients with NG may be upgraded from stages N1 to N2. NG was also a marker for identifying patients who would benefit from IC.
Key Points
•
Nodal grouping, defined as the presence of at least three contiguous LNs within one LN region on MRI, was identified as a significant prognostic factor.
•
In patients with nasopharyngeal carcinoma, nodal grouping may influence lymph node staging.
•
Nodal grouping was a marker for identifying patients who may benefit from induction chemotherapy.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31811429</pmid><doi>10.1007/s00330-019-06537-6</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-3977-0518</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0938-7994 |
| ispartof | European radiology, 2020-04, Vol.30 (4), p.2115-2124 |
| issn | 0938-7994 1432-1084 |
| language | eng |
| recordid | cdi_proquest_journals_2375288358 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Adult Cancer Chemotherapy Confidence intervals Diagnostic Radiology Female Head and Neck Humans Imaging Induction Chemotherapy - methods Internal Medicine Interventional Radiology Lymph nodes Lymph Nodes - pathology Lymphatic Metastasis Magnetic resonance imaging Magnetic Resonance Imaging - methods Male Markers Medical prognosis Medicine Medicine & Public Health Metastases Middle Aged Nasopharyngeal carcinoma Nasopharyngeal Carcinoma - classification Nasopharyngeal Carcinoma - drug therapy Nasopharyngeal Carcinoma - secondary Nasopharyngeal Neoplasms - classification Nasopharyngeal Neoplasms - diagnosis Nasopharyngeal Neoplasms - drug therapy Neoplasm Staging Neuroradiology Prognosis Progression-Free Survival Radiology Regression analysis Regression models Retrospective Studies Statistical analysis Survival Throat cancer Ultrasound |
| title | Nodal grouping in nasopharyngeal carcinoma: prognostic significance, N classification, and a marker for the identification of candidates for induction chemotherapy |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-29T03%3A29%3A02IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Nodal%20grouping%20in%20nasopharyngeal%20carcinoma:%20prognostic%20significance,%20N%20classification,%20and%20a%20marker%20for%20the%20identification%20of%20candidates%20for%20induction%20chemotherapy&rft.jtitle=European%20radiology&rft.au=Liu,%20Yifei&rft.date=2020-04-01&rft.volume=30&rft.issue=4&rft.spage=2115&rft.epage=2124&rft.pages=2115-2124&rft.issn=0938-7994&rft.eissn=1432-1084&rft_id=info:doi/10.1007/s00330-019-06537-6&rft_dat=%3Cproquest_cross%3E2375288358%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2375288358&rft_id=info:pmid/31811429&rfr_iscdi=true |