Unambiguous advanced radiologic extranodal extension determined by MRI predicts worse outcomes in nasopharyngeal carcinoma: Potential improvement for future editions of N category systems

医学 鼻咽癌 队列 危险系数 内科学 卡帕 肿瘤科 核医学 置信区间 放射治疗 数学 几何学
作者
Yan‐Ping Mao,Shunxin Wang,William M. Lydiatt,Jatin P. Shah,A. Dimitrios Colevas,Anne W.M. Lee,Brian O’Sullivan,Rui Guo,Wei‐Jie Luo,Yu‐Pei Chen,Li Tian,Ling‐Long Tang,Ying Sun,Lizhi Liu,Jian Ren,Jun Ma
出处
期刊:Radiotherapy and Oncology [Elsevier BV]
卷期号:157: 114-121 被引量:48
标识
DOI:10.1016/j.radonc.2021.01.015
摘要

Background and purpose To explore the prognostic value of different radiologic extranodal extension (rENE) grades and their potential improvement for the 8th edition N category in nasopharyngeal carcinoma (NPC). Materials and methods From 2009 to 2013, a cohort of 1887 patients with NPC was retrospectively enrolled and randomized to the training (n = 955) and validation (n = 932) groups. rENE was categorized as follows: grade 0, nodes without rENE; grade 1, nodes with rENE infiltrating the surrounding fat only; grade 2, matted nodes; grade 3, nodes with rENE infiltrating adjacent structures. Results The percentage of patients with MRI-positive cervical nodes was 66.5% (1254/1887), of whom grade 0, 1, 2 and 3 rENE cases accounted for 33.2% (416/1254), 14.9% (187/1254), 36.5% (458/1254) and 15.4% (193/1254), respectively. The kappa coefficients for the inter-rater and intra-rater assessments were 0.63, 0.51, 0.65 and 0.93, and 0.76, 0.69, 0.72 and 1.0 in grade 0, 1, 2 and 3 rENE, respectively. Grade 3 rENE rather than grades 0–2 rENE was an independent unfavorable predictor of overall survival and disease-free survival (P < 0.001). Recursive partitioning analysis was applied to refine the N category: eN0 (N0), eN1 (N1 without grade 3), eN2 (N2 without grade 3), and eN3 (N1/N2 with grade 3, N3). Compared to the current system, the proposed N category performed better in hazard consistency, hazard discrimination, sample size balance and outcome prediction. Conclusion Grade 3 rENE was an independent unfavorable indicator of NPC. Upstaging patients in N1-2 with grade 3 rENE to N3 led to a superior prognostic performance.
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