预测手术治疗的口咽癌和下咽癌中隐匿性咽后淋巴结转移：一个整合的临床-放射学模型

文献信息

中文摘要

背景： 在手术治疗的口咽和下咽鳞状细胞癌（SCC）中，经病理证实的咽后淋巴结（RPLN）转移的临床意义和真实发生率仍不清楚，尤其是对于小的隐匿性病变。
方法： 我们回顾性评估了235例手术患者（2005-2024年）。RPLN阳性通过病理证实，或定义为在未进行初始RPLN治疗的情况下1年内出现延迟复发。开发了多变量逻辑回归模型，以优化结合的多模态影像标准（CT、MRI和FDG-PET）和临床特征。
结果： 严格依赖多模态影像学发现（使用5-mm MRI短轴截断值）的诊断灵敏度仅为0.48。然而，将独立的临床预测因素——后壁延伸（OR：3.50）和多个同侧II级转移（OR：3.47）——纳入最终模型，在概率阈值为0.15时，灵敏度显著扩大至0.74，同时保持高特异性（0.93）和诊断准确性（0.90）。
结论： 将放射学发现与临床风险因素相结合，显著增强了对隐匿性RPLN转移的预测，为个体化手术计划和术后监测提供了可靠的框架。

英文摘要

BACKGROUND: The clinical significance and true incidence of pathologically confirmed retropharyngeal lymph node (RPLN) metastasis in surgically treated oropharyngeal and hypopharyngeal squamous cell carcinoma (SCC) remain unclear, particularly regarding small, occult lesions.
METHODS: We retrospectively evaluated 235 surgical patients (2005-2024). RPLN positivity was pathologically confirmed or defined by delayed recurrence within 1 year without initial RPLN treatment. Multivariable logistic regression models were developed to optimize combined multimodal imaging criteria (CT, MRI, and FDG-PET) and clinical features.
RESULTS: Relying strictly on multimodal imaging findings (using a 5-mm MRI short-axis cutoff) yielded a diagnostic sensitivity of only 0.48. However, incorporating independent clinical predictors-posterior wall extension (OR: 3.50) and multiple ipsilateral Level II metastases (OR: 3.47)-into the final model at a probability threshold of 0.15 significantly expanded sensitivity to 0.74 while maintaining high specificity (0.93) and diagnostic accuracy (0.90).
CONCLUSION: Combining radiological findings with clinical risk factors significantly enhances the prediction of occult RPLN metastasis, providing a reliable framework for individualized surgical planning and postoperative surveillance.