鼻咽癌中基于CT和MRI的影像学结外扩展分级的信度和效度
Reliability and Validity of Imaging-derived Extranodal Extension Grading Using CT and MRI in Nasopharyngeal Carcinoma.
文献信息
| PMID | 42770822 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Pae Sun Suh |
| 作者单位 | Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea. |
| 期刊 | Radiology |
| SCI 分区 | Q1 |
| IF | 15.5 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
背景： 影像学结外扩展（iENE）被纳入第九版肿瘤-淋巴结-转移（TNM）分期系统中鼻咽癌（NPC）的N3标准。目的：评估联合工作组提出的iENE分级系统在NPC中的信度和预后价值。材料与方法：这项回顾性单中心研究纳入2007年1月至2025年3月期间接受治疗的NPC患者。对于有颈部淋巴结转移的患者，三名放射科医生使用提出的四级分类系统在治疗前CT和/或MRI上独立对iENE进行分级。使用组内相关系数（ICC）和加权κ评估评分者间和评分者内信度。使用Kaplan-Meier和多变量Cox回归分析（调整年龄、性别、T和M分期以及化疗状态）评估不同iENE分级的总体生存期（OS）、无病生存期、局部区域无复发生存期和远处无转移生存期（DMFS）。结果：共纳入401例患者（中位年龄52岁[IQR，44-60岁]；296例男性）。根据基于共识的最终iENE分级，分别有223、36、94和48例患者被分类为iENE 0、1、2和3级。iENE分级的评分者间信度（ICC，0.87 [95% CI：0.85，0.89]）和评分者内信度（κ = 0.95）极好。与iENE 0级患者相比，iENE 3级患者的OS更短（风险比，3.30 [95% CI：1.70，6.41]；P < .001）。此外，iENE 1、2和3级患者的DMFS比iENE 0级患者更短，风险比分别为2.33（95% CI：1.12，4.87；P = .02）、2.11（95% CI：1.24，3.60；P = .006）和2.39（95% CI：1.28，4.45；P = .006）。TNM-8和TNM-9系统之间的预后性能没有差异证据。结论：联合工作组iENE分级系统在NPC患者中具有极好的信度和良好的预后价值。© RSNA，2026。本文有补充材料。
英文摘要
Background Imaging-derived extranodal extension (iENE) was added to the N3 criteria for nasopharyngeal carcinoma (NPC) in the ninth version of the tumor-node-metastasis (TNM) staging system. Purpose To evaluate the reliability and prognostic value of a proposed joint task force iENE grading system in NPC. Materials and Methods This retrospective single-center study included patients with NPC treated between January 2007 and March 2025. For patients with cervical lymph node metastases, three radiologists independently graded iENE at pretreatment CT and/or MRI using the proposed four-tier classification system. Inter- and intrarater reliability was assessed using the intraclass correlation coefficient (ICC) and weighted κ. Overall survival (OS), disease-free survival, local-regional recurrence-free survival, and distant metastasis-free survival (DMFS) were evaluated across iENE grades using Kaplan-Meier and multivariable Cox regression analyses adjusted for age, sex, T and M categories, and chemotherapy status. Results A total of 401 patients (median age, 52 years [IQR, 44-60 years]; 296 male patients) were included. According to the consensus-based final iENE grades, 223, 36, 94, and 48 patients were classified as having iENE grade 0, 1, 2, and 3, respectively. Interrater reliability (ICC, 0.87 [95% CI: 0.85, 0.89]) and intrarater reliability (κ = 0.95) for iENE grading were excellent. Compared with patients with iENE grade 0, patients with iENE grade 3 had shorter OS (hazard ratio, 3.30 [95% CI: 1.70, 6.41]; P < .001). In addition, patients with iENE grade 1, 2, and 3 had shorter DMFS than patients with iENE grade 0, with hazard ratios of 2.33 (95% CI: 1.12, 4.87; P = .02), 2.11 (95% CI: 1.24, 3.60; P = .006), and 2.39 (95% CI: 1.28, 4.45; P = .006), respectively. There was no evidence of a difference in prognostic performance between the TNM-8 and TNM-9 systems. Conclusion The joint task force iENE grading system had excellent reliability and good prognostic value in patients with NPC. © RSNA, 2026 Supplemental material is available for this article.