Patterns and prognostic value of lymph node metastasis of nasopharyngeal carcinoma based on 2013 updated consensus guidelines of neck node levels

区晓敏; 周鑫; 史琪

doi:10.3969/j.issn.1007-3969.2015.07.008

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Patterns and prognostic value of lymph node metastasis of nasopharyngeal carcinoma based on 2013 updated consensus guidelines of neck node levels

更新时间：2025-12-31

- Patterns and prognostic value of lymph node metastasis of nasopharyngeal carcinoma based on 2013 updated consensus guidelines of neck node levels
- China Oncology Vol. 25, Issue 7, Pages: 535-543(2015)
- 作者机构：
  
  复旦大学附属肿瘤医院放疗科，复旦大学上海医学院肿瘤学系,上海,200032
- 作者简介：
- 基金信息：
- DOI：10.3969/j.issn.1007-3969.2015.07.008
  CLC：
- Published Online：09 December 2015，
  
  Published：09 December 2015
- 稿件说明：
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区晓敏,周鑫,史琪,等. 基于2013版颈部淋巴结分区指南的鼻咽癌淋巴结转移规律与预后价值研究[J]. 中国癌症杂志, 2015, 25(7): 535-543.

区晓敏, 周鑫, 史琪. Patterns and prognostic value of lymph node metastasis of nasopharyngeal carcinoma based on 2013 updated consensus guidelines of neck node levels[J]. China Oncology, 2015, 25(7): 535-543.
区晓敏,周鑫,史琪,等. 基于2013版颈部淋巴结分区指南的鼻咽癌淋巴结转移规律与预后价值研究[J]. 中国癌症杂志, 2015, 25(7): 535-543. DOI： 10.3969/j.issn.1007-3969.2015.07.008.

区晓敏, 周鑫, 史琪. Patterns and prognostic value of lymph node metastasis of nasopharyngeal carcinoma based on 2013 updated consensus guidelines of neck node levels[J]. China Oncology, 2015, 25(7): 535-543. DOI： 10.3969/j.issn.1007-3969.2015.07.008.

摘要

背景与目的：2013年欧洲肿瘤学会官方杂志Radiotherapy Oncology发表了新版头颈部肿瘤颈部淋巴结分区指南，对规范颈部淋巴结靶区的勾画有重要意义。该研究采用2013版颈部淋巴结分区指南，旨在探讨鼻咽癌颈部淋巴结转移规律，以及颈部淋巴结影像特征与预后的关系，为将来修订N分期提供依据。方法：回顾性分析本院2009年1月—2010年12月病理诊断明确的、初诊无远处转移、接受调强放射治疗的鼻咽癌患者656例。所有患者治疗前行鼻咽和颈部MRI扫描。回顾分析所有患者的MRI图像，并根据2013版颈部淋巴结分区指南进行重新分区，分析颈部淋巴结转移的影像学特征与预后的关系。结果：中位随访时间为46.9个月。4年无局部复发生存率为91.3%，4年无颈部复发生存率为95.1%，4年无远处转移生存率为87.7%，4年无病生存率为78.5%，4年总生存率为92.8%。最常见的颈部淋巴结转移分区为：Ⅱ区76.2%，Ⅶa区65.1%，其次为Ⅲ区(50.4%)，Ⅴa(17.5%)和Ⅳa(11.7%)。淋巴结的跳跃转移率为1.0%。颈部淋巴结阳性的患者中，46.4%的患者有淋巴结坏死，74.4%的患者有包膜外侵犯。单因素分析显示，颈部淋巴结受累侧数、颈部淋巴结最大径≥6 cm、颈部淋巴结坏死、T分期和N分期都是影响无远处转移生存和无病生存的因素(P0.05)。淋巴结包膜外侵犯有影响无远处转移生存率的趋势(P=0.060)。环状软骨下缘以下的颈部分区受累对无远处转移生存和无病生存无显著影响。多因素分析发现，T分期、淋巴结最大径是影响无远处转移生存的独立预后因素(P0.05)；T分期、淋巴结最大径和淋巴结坏死是影响无病生存的独立预后因素(P0.05)。结论：该研究阐明了鼻咽癌颈部淋巴结转移规律，发现颈部淋巴结受累侧数、淋巴结最大径、淋巴结坏死是影响远处转移和无病生存的重要因素。下颈部受累对无远处转移生存和无病生存无显著影响。

Abstract

Background and purpose: In 2013

the official journal of European Society of Radiotherapy Oncology (ESTRO) - Radiotherapy Oncology published the updated version of Consensus Guidelines of Delineation of the neck node levels for head and neck tumors

which contributed to the standardization of description of neck nodal metastasis

as well as reduction of treatment variations from various institutions. This study applied this updated guidelines to analyze the patterns of lymph node metastasis of nasopharyngeal carcinoma and explore the prognostic value of the radiologic characteristics of nodes

in order to provide evidence for future revision of N staging system. Methods: A total of 656 patients from Jan. 2009 to Dec. 2010 were retrospectively recruited to analysis. All were pathologically diagnosed as non-metastatic nasopharyngeal carcinoma

treated with intensity-modulated radiotherapy. All patients received a pretreatment MRI scan. We retrospectively reviewed the MRI imaging of 656 patients and mapped the lymph node metastasis using the 2013 International Consensus Guidelines. Results: Median follow-up was 46.9 months. Four-year local recurrence-free survival

nodal recurrence-free survival

distant metastasis-free survival

disease-free survival and overall survival was 91.3%

95.1%

87.7%

78.5% and 92.8%

respectively. The most common metastatic node levels were level Ⅱ (76.2%) and level Ⅶa (65.1%)

followed by level Ⅲ (50.4%)

Ⅴa(17.5%) and Ⅳa (11.7%). There was a very low incidence of node skipping (1.0%). Cervical nodal necrosis was observed in 46.4% of patients with positive nodes and extracapsular spread was noted in 74.4% of them. Univariate analysis showed that bilateral nodal involvement

greatest dimension of positive nodes (≥6 cm)

central nodal necrosis

T stage and N stage were prognostic factors for disease-free survival and distant metastasis-free survival (P0.05). Extracapsular spread showed a trend to correlate with poor distant metastasis-free survival (P=0.060). The involvement of lower neck levels (below the caudal border of cricoid cartilage) did not have a significant impact on disease-free survival and distant metastasis-free survival. In multivariate analysis

T stage and greatest dimension of nodes (≥6 cm) were independent prognostic factors for distant metastasis-free survival (P0.05). T stage

greatest dimension of nodes (≥6 cm) and central nodal necrosis were independent prognostic factors of disease-free survival (P0.05). Conclusion: This study demonstrates the patterns of lymph node metastasis of nasopharyngeal carcinoma based on 2013 International Consensus Guidelines. Bilateral nodal involvement

greatest dimension of positive nodes and central nodal necrosis had prognostic values on disease-free survival and distant metastasis-free survival. In our study

the involvement of lower neck levels was not proved to be a prognostic factor for disease-free survival and distant metastasis-free survival.

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