Matted Lymph Nodes on MRI in Nasopharyngeal Carcinoma: Prognostic Factor and Potential Indication for Induction Chemotherapy Benefits

Background Lymph node characteristics markedly affect nasopharyngeal carcinoma (NPC) prognosis. Matted node (MN), an important characteristic for lymph node, lacks explored MRI‐based prognostic implications. Purpose Investigate MRI‐determined MNs' prognostic value in NPC, including 5‐year overall survival (OS), distant metastasis‐free survival (DMFS), local recurrence‐free survival (LRFS), progression‐free survival (PFS), and its role in induction chemotherapy (IC). Study Type Retrospective cohort survival study. Population Seven hundred ninety‐two patients with non‐metastatic NPC (female: 27.3%, >45‐year old: 50.1%) confirmed by biopsy. Field Strength/Sequence 5‐T /3. 0‐T , T1 ‐, T2 ‐ and post‐contrast T1 ‐weighted fast spin echo sequences acquired. Assessment MNs were defined as ≥3 nodes abutting with intervening fat plane replaced by extracapsular nodal spread (ENS). Patients were observed every 3 months for 2 years and every 6 months for 5 years using MRI. Follow‐up extended from treatment initiation to death or final follow‐up. MNs were evaluated by three radiologists with inter‐reader reliability calculated. A 1:1 matched‐pair method compared survival differences between MN‐positive patients with or without IC. Primary endpoints (OS, DMFS, LRFS, PFS) were calculated from therapy initiation to respective event. Statistical Tests Kappa values assessed inter‐reader reliability. Correlation between MN, ENS, and LNN was studied through Spearman's correlation coefficient. Clinical characteristics were calculated via Fisher's exact, Chi‐squared, and Student's t ‐test. Kaplan–Meier curves and log‐rank tests analyzed all time‐to‐event data. Confounding factors were included in Multivariable Cox proportional hazard models to identify independent prognostic factors. P ‐values <0.05 were considered statistically significant. Results MNs incidence was 24.6%. MNs independently associated with decreased 5‐year OS, DMFS, and PFS; not LRFS ( P = 0.252). MN‐positive patients gained significant survival benefit from IC in 5‐year OS (88.4% vs. 66.0%) and PFS (76.4% vs. 53.5%), but not DMFS (83.1% vs. 69.9%, P = 0.145) or LRFS (89.9% vs. 77.8%, P = 0.140). Data Conclusion MNs may independently stratify NPC risk and offer survival benefit from IC. Evidence Level 3 Technical Efficacy Stage 2