基于mri的N1-N2期鼻咽癌中颈部受累：危险分层的标志。

IF 15.2 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiology Pub Date : 2025-08-01 DOI:10.1148/radiol.243399

Guan-Jie Qin, Wei Jiang, Wu-Qi Zhang, Wen-Fei Li, Gao-Yuan Wang, Yan-Ping Mao, Shun-Xin Wang, Zhe Dong, Yu-Pei Chen, Cheng Xu, Kai-Bin Yang, Yuan Zhang, Ying-Qi Lu, Na Liu, Lei Chen, Rui Guo, Ling-Long Tang, Ying Sun, Ji-Bin Li, Li-Zhi Liu, Xiao-Jing Du, Jun Ma

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Survival analysis was performed by incorporating TN category and middle neck involvement. Kaplan-Meier curves and the log-rank test were used to compare survival outcomes. Results This study included 9795 patients (mean age, 45 years ± 11 [SD]; 7135 male). Middle neck involvement was identified in 17.0% of patients (1668 of 9795), with prevalence rates of 11.4% (848 of 7429) in the N1 subgroup and 34.7% (820 of 2366) in the N2 subgroup. Multivariable analysis revealed that middle neck involvement was an independent prognostic factor for reduced metastasis-free survival (MFS), overall survival (OS), and disease-free survival (DFS) in both the N1 (all P < .001) and N2 subgroups (P = .001, .02, and .04, respectively). Patients with T1-T2 N1 NPC with middle neck involvement exhibited survival outcomes comparable to those in patients with T1-T2 N2 NPC (all P > .05). Conversely, patients with T3N1 disease without middle neck involvement had better 5-year MFS (91.7% vs 84.6%; P < .001), OS (90.6% vs 84.3%; P = .003), and DFS (83.6% vs 74.4%; P < .001) than those with middle neck involvement. Conclusion Middle neck involvement serves as a critical factor for risk stratification in N1 and N2 NPC. It helps identify patients at high risk within the T1-T2 N1 subgroup and those with T3N1 disease. © RSNA, 2025 Supplemental material is available for this article. 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Purpose To investigate the prognostic significance of middle neck involvement in patients with N1 or N2 NPC. Materials and Methods This retrospective analysis included patients with N1 or N2 NPC without distant metastasis treated between April 2009 and December 2017. Patients were categorized according to the presence or absence of middle neck involvement, as determined at MRI. Survival analysis was performed by incorporating TN category and middle neck involvement. Kaplan-Meier curves and the log-rank test were used to compare survival outcomes. Results This study included 9795 patients (mean age, 45 years ± 11 [SD]; 7135 male). Middle neck involvement was identified in 17.0% of patients (1668 of 9795), with prevalence rates of 11.4% (848 of 7429) in the N1 subgroup and 34.7% (820 of 2366) in the N2 subgroup. Multivariable analysis revealed that middle neck involvement was an independent prognostic factor for reduced metastasis-free survival (MFS), overall survival (OS), and disease-free survival (DFS) in both the N1 (all P < .001) and N2 subgroups (P = .001, .02, and .04, respectively). Patients with T1-T2 N1 NPC with middle neck involvement exhibited survival outcomes comparable to those in patients with T1-T2 N2 NPC (all P > .05). Conversely, patients with T3N1 disease without middle neck involvement had better 5-year MFS (91.7% vs 84.6%; P < .001), OS (90.6% vs 84.3%; P = .003), and DFS (83.6% vs 74.4%; P < .001) than those with middle neck involvement. Conclusion Middle neck involvement serves as a critical factor for risk stratification in N1 and N2 NPC. It helps identify patients at high risk within the T1-T2 N1 subgroup and those with T3N1 disease. © RSNA, 2025 Supplemental material is available for this article. 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引用次数: 0

摘要

鼻咽癌（NPC）中颈部受累（定义为舌骨尾缘和环状软骨之间的颈部淋巴结转移）的预后意义尚不清楚。目的探讨中颈部受累对N1或N2鼻咽癌患者预后的影响。材料与方法回顾性分析2009年4月至2017年12月期间接受治疗的N1或N2型鼻咽癌无远处转移的患者。根据MRI确定的中颈部受累与否对患者进行分类。合并TN类别和中颈部受累进行生存分析。Kaplan-Meier曲线和log-rank检验用于比较生存结果。结果纳入9795例患者，平均年龄45岁±11岁[SD]，男性7135例。17.0%的患者（9795例中1668例）中颈部受累，其中N1亚组患病率为11.4%（7429例中848例），N2亚组患病率为34.7%（2366例中820例）。多变量分析显示，中颈部受累是N1亚组（P < 0.001）和N2亚组（P = 0.001）无转移生存期（MFS）、总生存期（OS）和无病生存期（DFS）降低的独立预后因素。02，和。分别为04)。伴有中颈部受累的T1-T2 N1型鼻咽癌患者的生存结果与T1-T2 N2型鼻咽癌患者相当（P < 0.05）。相反，不累及中颈部的T3N1患者的5年MFS （91.7% vs 84.6%, P < 0.001）、OS （90.6% vs 84.3%, P = 0.003）和DFS （83.6% vs 74.4%, P < 0.001）优于中颈部累及患者。结论中颈受累是N1和N2鼻咽癌危险分层的关键因素。它有助于识别T1-T2 N1亚组中的高危患者和T3N1疾病患者。©RSNA， 2025本文可获得补充材料。另见Jabehdar Maralani和Kang在本期的社论。

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MRI-based Middle Neck Involvement in Stage N1-N2 Nasopharyngeal Carcinoma: A Marker for Risk Stratification.

Background The prognostic implications of middle neck involvement, defined as cervical lymph node metastasis between the caudal border of the hyoid bone and the cricoid cartilage, remain unclear in nasopharyngeal carcinoma (NPC). Purpose To investigate the prognostic significance of middle neck involvement in patients with N1 or N2 NPC. Materials and Methods This retrospective analysis included patients with N1 or N2 NPC without distant metastasis treated between April 2009 and December 2017. Patients were categorized according to the presence or absence of middle neck involvement, as determined at MRI. Survival analysis was performed by incorporating TN category and middle neck involvement. Kaplan-Meier curves and the log-rank test were used to compare survival outcomes. Results This study included 9795 patients (mean age, 45 years ± 11 [SD]; 7135 male). Middle neck involvement was identified in 17.0% of patients (1668 of 9795), with prevalence rates of 11.4% (848 of 7429) in the N1 subgroup and 34.7% (820 of 2366) in the N2 subgroup. Multivariable analysis revealed that middle neck involvement was an independent prognostic factor for reduced metastasis-free survival (MFS), overall survival (OS), and disease-free survival (DFS) in both the N1 (all P < .001) and N2 subgroups (P = .001, .02, and .04, respectively). Patients with T1-T2 N1 NPC with middle neck involvement exhibited survival outcomes comparable to those in patients with T1-T2 N2 NPC (all P > .05). Conversely, patients with T3N1 disease without middle neck involvement had better 5-year MFS (91.7% vs 84.6%; P < .001), OS (90.6% vs 84.3%; P = .003), and DFS (83.6% vs 74.4%; P < .001) than those with middle neck involvement. Conclusion Middle neck involvement serves as a critical factor for risk stratification in N1 and N2 NPC. It helps identify patients at high risk within the T1-T2 N1 subgroup and those with T3N1 disease. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Jabehdar Maralani and Kang in this issue.

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来源期刊

Radiology 医学-核医学

CiteScore

35.20

自引率

3.00%

发文量

596

审稿时长

3.6 months

期刊介绍： Published regularly since 1923 by the Radiological Society of North America (RSNA), Radiology has long been recognized as the authoritative reference for the most current, clinically relevant and highest quality research in the field of radiology. Each month the journal publishes approximately 240 pages of peer-reviewed original research, authoritative reviews, well-balanced commentary on significant articles, and expert opinion on new techniques and technologies. Radiology publishes cutting edge and impactful imaging research articles in radiology and medical imaging in order to help improve human health.