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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2018.595    [Accepted]
Prognostic Value and Staging Classification of Lymph Nodal Necrosis in Nasopharyngeal Carcinoma after Intensity-Modulated Radiotherapy
Yanru Feng, Caineng Cao, Qiaoying Hu, Xiaozhong Chen
Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
Correspondence  Xiaozhong Chen ,Tel: 86-571-88128202, Fax: 86-571-88122062, Email: chenxiaozhong2016@163.com
Received: October 31, 2018;  Accepted: December 26, 2018.  Published online: December 27, 2018.
ABSTRACT
Purpose
The aim of the present study was to evaluate the prognostic value of magnetic resonance imaging (MRI)‒determined lymph nodal necrosis (LNN) in nasopharyngeal carcinoma (NPC) and explore the feasibility of an N-classification system based on the 8th edition of the American Joint Committee on Cancer (AJCC) system.
Materials and Methods
The MRI scans of 616 patients with newly diagnosed stage T1-4N1-3M0 NPC who were treated with definitive intensity-modulated radiotherapy (IMRT) were reviewed.
Results
Multivariate analysis showed that LNN was an independent negative prognostic predictor of distant metastasis free survival (hazard ratio, 1.634; 95% confidence interval, 1.023 to 2.609; p=0.040) and overall survival (hazard ratio, 2.154; 95% confidence interval, 1.282 to 3.620; p=0.004). Patients of classification N1 disease with LNN were reclassified as classification N2, and classification N2 disease with LNN as classification N3 in the proposed N-classification system. Correlation with death and distant failure was significant, and the total difference between N1 and N3 was wider with the proposed system.
Conclusion
MRI-determined LNN is an independent negative prognostic factor for NPC. The proposed N classification system is powerfully predictive.
Key words: Nasopharyngeal carcinoma, Lymph nodes, Intensity-modulated radiotherapy, Prognosis, Neoplasm staging
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