治疗前MRI定义的坏死性淋巴结表型识别N3期鼻咽癌远处转移风险异质性
Pretreatment MRI-defined necrotic nodal phenotypes identify distant metastasis risk heterogeneity in N3 nasopharyngeal carcinoma.
文献信息
| PMID | 42710462 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Yuwei Wang |
| 作者单位 | Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China. |
| 期刊 | Oral oncology |
| SCI 分区 | Q1 |
| IF | 4.6 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
背景： 远处转移仍然是接受根治性调强放疗（IMRT）的鼻咽癌（NPC）患者治疗失败的主要原因，尤其是在晚期淋巴结病变患者中。尽管淋巴结坏死（LNN）是一种不良影像学特征，但其预后意义可能因伴随的淋巴结特征而异。
方法： 这项回顾性队列研究纳入了2016年至2023年间接受根治性IMRT治疗的800例新诊断淋巴结阳性非转移性NPC患者。对治疗前MRI进行回顾，评估LNN相关特征，包括影像学结外侵犯（rENE）、坏死性淋巴结负荷和解剖分布。采用Cox回归和重叠权重评估与无远处转移生存（DMFS）的相关性。
结果： 在800例患者中，450例（56.3%）存在LNN。经过重叠权重调整后，LNN仍与较差的DMFS独立相关（5年DMFS，87.0% vs. 94.2%；加权HR，2.26；95% CI，1.24-4.12；P = 0.008）。在LNN患者中，重度rENE、较高的坏死性淋巴结负荷和多区域坏死与转移风险增加相关。预先定义的不良坏死性淋巴结表型未能进一步区分N2期疾病，但在N3期疾病中识别出显著异质性，N3b期患者较N3a期患者DMFS更差（HR，2.52；95% CI，1.18-5.39；P = 0.017）。
结论： 治疗前MRI定义的坏死性淋巴结表型在LNN之外提供了额外的风险分层，并可能识别出远处转移风险增加的N3期NPC患者亚组。这些发现需要在临床实施前进行外部验证。
英文摘要
BACKGROUND: Distant metastasis remains a major cause of treatment failure in nasopharyngeal carcinoma (NPC) treated with definitive intensity-modulated radiotherapy (IMRT), particularly among patients with advanced nodal disease. Although lymph node necrosis (LNN) is an adverse imaging feature, its prognostic significance may vary according to accompanying nodal characteristics.
METHODS: This retrospective cohort study included 800 patients with newly diagnosed node-positive non-metastatic NPC treated with definitive IMRT between 2016 and 2023. Pretreatment MRI was reviewed for LNN-related features, including radiologic extranodal extension (rENE), necrotic nodal burden, and anatomic distribution. Associations with distant metastasis-free survival (DMFS) were assessed using Cox regression and overlap weighting.
RESULTS: Among 800 patients, 450 (56.3%) had LNN. After overlap weighting, LNN remained independently associated with inferior DMFS (5-year DMFS, 87.0% vs. 94.2%; weighted HR, 2.26; 95% CI, 1.24-4.12; P = 0.008). Among patients with LNN, severe rENE, higher necrotic nodal burden, and multi-area necrosis were associated with increased metastatic risk. The predefined adverse necrotic nodal phenotype did not further stratify N2 disease but identified significant heterogeneity within N3 disease, with inferior DMFS in N3b compared with N3a patients (HR, 2.52; 95% CI, 1.18-5.39; P = 0.017).
CONCLUSIONS: Pretreatment MRI-defined necrotic nodal phenotypes provide additional risk stratification beyond LNN alone and may identify a subgroup of N3 NPC patients with increased risk of distant metastasis. These findings require external validation before clinical implementation.