Abstract：Objective To propose a new N staging system for nasopharyngeal carcinoma based on intensity-modulated radiotherapy (IMRT) and Radiation Therapy Oncology Group (RTOG) guidelines for cervical lymph node levels.Methods A retrospective analysis was performed in 324 patients with newly diagnosed nasopharyngeal carcinoma who had no distant metastasis confirmed by pathology and received IMRT in the Department of Radiation Oncology in The First Affiliated Hospital of Guangxi Medical University from January 2010 to December 2011.They were restaged according to the 7th edition of UICC/AJCC staging system for nasopharyngeal carcinoma. The survival rates were estimated using the Kaplan-Meier method and the log-rank test was used for univariate prognostic analysis. The Cox proportional hazards model was used for multivariate prognostic analysis. Results Of 324 patients,269(83.0%) had lymph node metastasis. The median follow-up was 58 months (6-77 months).The 5-year overall survival,disease-free survival,relapse-free survival,and distant metastasis-free survival rates were 84.8%,77.1%,92.7%,and 80.5%,respectively. Univariate and multivariate analyses of patients with positive cervical lymph nodes revealed that retropharyngeal lymph node status,cervical lymph node level,and laterality were evaluated as independent prognostic factors for nasopharyngeal carcinoma. According to the hazard ratio calculated,the N staging system was revised as follows:N0:no regional lymph node metastasis;N1:VⅡ a or/and unilateral levels (I,Ⅱ,Ⅲ,Va) involvement;N2:bilateral levels (I,Ⅱ,Ⅲ,Va) involvement;N3:levels IVa,Vb,and IVb+Vc involvement. Conclusions The proposed N staging system is based on IMRT and RTOG guidelines for lymph node levels and more practical,and can provide highly Objective prediction of outcome and guide treatment in nasopharyngeal carcinoma.
Kang Min,Zhao Tingting,Zhou Pingting et al. Study on N staging system for nasopharyngeal carcinoma based on intensity-modulated radiotherapy and RTOG guidelines for cervical lymph node levels[J]. Chinese Journal of Radiation Oncology, 2017, 26(5): 501-507.
[1] Kang M,Long J,Li G,et al. A new staging system for nasopharyngeal carcinoma based on intensity-modulated radiation therapy:results of a prospective multicentric clinical study[J].Oncotarget,2016,7(12):15252-1526.DOI:10.18632/oncotarget.7553 [2] Chen WS,Li JJ,Hong L,et al. Diagnostic Value of magnetic resonance spectroscopy in radiation encephalopathy induced by radiotherapy for patients with nasopharyngeal carcinoma:a Meta-analysis[J].Biomed Res Int,2016,2016:5126074.DOI:10.1155/2016/5126074. [3] Lai SZ,Li WF,Chen L,et al. How does intensity-modulated radiotherapy versus conventional two-dimensional radiotherapy influence the treatment results in nasopharyngeal carcinoma patients[J].Int J Radiat Oncol Biol Phys,2011,80(3):661-668.DOI:10.1155/2016/5126074. [4] Grégoire V,Ang K,Budach W,et al. Delineation of the neck node levels for head and neck tumors:a 2013 update[J].Radiother Oncol,2014,110(1):172-181.DOI:10.1016/j.radonc.2013.10.010. [5] 郑宝敏,刘颖.咽后淋巴结转移在鼻咽癌调强放疗预后中的意义[J].中华放射医学与防护杂志,2014,34(1):34-36. Zheng BM,Liu Y.Prognostic significance of intensity modulated radiotherapy with retropharyngeal lymph node metastasis[J].Chin J Radiol Med Protect,2014,34(1):34-36.DOI:10.3760/cma.j.issn.0254-5098.2014.01.009. [6] 项红霞,黎静.鼻咽癌淋巴结转移诊断标准的研究进展[J].现代肿瘤医学,2013(05):1140-1142.DOI:10.3969/j.issn.1672-4992.2013.05.68. Xiang HX,Li J.Research progress in diagnosis of metastatic lymph nodes in nasopharyngeal carcinoma standard[J].Mod Oncol,2013(05):1140-1142.DOI:10.3969/j.issn.1672-4992.2013.05.68. [7] 殷蔚伯,余子豪,徐国镇,等.肿瘤放射治疗学[M].第4 版.北京:中国协和医科大学出版社,2008:451. Yin WB,Yu ZH,Xu GZ,et al. Radiation oncology[M].4 ed. Beijing:Peking Union Medical College press,2008:451. [8] Tang L,Mao Y,Liu L,et al. The volume to be irradiated during selective neck irradiation in nasopharyngeal carcinoma:analysis of the spread patterns in lymph nodes by magnetic resonance imaging[J],Cancer,2009,115(3):680-688.DOI:10.1002/cncr.24049. [9] Wang XS,Yan C,Hu CS,et al. Study of the medial group retropharyngeal node metastasis from nasopharyngeal carcinoma based on 3100 newly diagnosed cases[J].Oral Oncol,2014,50(11):1109-1113.DOI:10.1016/j.oraloncology.2014.08.007. [10] Wang X,Hu C,Ying H.et al. Patterns of retropharyngeal node metastasis in nasopharyngeal carcinoma[J].Int J Radiat Oncol Biol Phys,2009,73(1):194-201.DOI:10.1016/j.ijrobp.2008.03.067. [11] Mao YP,Liang SB,Liu LZ,et al. The N staging system in nasopharyngeal carcinoma with radiation therapy oncology group guidelines for lymph node levels based on magnetic resonance imaging[J].Clin Cancer Res,2008,14(22):7497-7503.DOI:10.1158/1078-0432.CCR-08-0271. [12] Leslie S,Mary G,Chreitiann W,et al. International union against cancer TNM classification of malignant tumours[M].7 ed. New Jersey:Wiley-Blackwell,2009:12-29. [13] Yue D, Xu YF, Zhang F,et al. Is replacement of the supraclavicular fossa with the lower level classification based on magnetic resonance imaging beneficial innasopharyngeal carcinoma?[J].Radiother Oncol,2014,113(1):108-114.DOI:10.1016/j.radonc.2014.08.036. [14] Li WF,Sun Y,Mao YP,et al. Proposed lymph node staging system using the International Consensus Guidelines for lymph node levels is predictive for nasopharyngeal carcinoma patients from endemic areas treated with intensity modulated radiation therapy[J].Int J Radiat Oncol Biol Phys,2013,86(2):249-256.DOI:10.1016/j.ijrobp.2012.09.003. [15] 高云生,许婷婷,何霞云,等.颈部淋巴结的最大径不是早期鼻咽癌单纯放疗的预后因素[J].中国癌症杂志,2012,22(10):761-765.DOI:10.3969/j.issn.1007-3969.2012.10.008. Gao YS,Xu TT,He XY,et al. Prognostic factors of maximal diameter of lymph node is not early nasopharyngeal carcinoma radiotherapy[J].Chin J Cancer,2012,22(10):761-765.DOI:10.3969/j.issn.1007-3969.2012.10.008. [16] Tang LL,Guo R,Ma J,et al. Prognostic value and staging classification of retro pharyngeal lymph node metastasis in nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy[J/OL].PLoS One,2014,9(10):e108375.DOI:10.1371/journal.pone.0108375. [17] 潘建基,宗井凤,林少俊,等.基于IMRT时代的第八版AJCC/UICC鼻咽癌临床分期建议[J].中华放射肿瘤学杂志,2016,25(3):197-205.DOI:10.3760/cma.j.issn.1004-4221.2016.03.002. Pan JJ,Zong JF,Lin SJ,et al. Recommended clinical stage of nasopharyngeal carcinoma based on IMRT era and eighth edition of AJCC/UICC staging[J].Chin J Radiat Oncol,2016,25(3):197-205.DOI:10.3760/cma.j.issn.1004-4221.2016.03.002. [18] 林少俊,陈晓钟,何侠,等.鼻咽癌前瞻性多中心临床分期研究的初步结果[J].中华放射肿瘤学杂志,2015,24(3):275-280.DOI:DOI:10.3760/cma.j.issn.1004-4221.2015.03.011. Lin SJ,Chen XZ,He X,et al. Preliminary results of a prospective multicenter clinical staging of nasopharyngeal carcinoma research[J].Chin J Radiat Oncol,2015,24(3):275-280.DOI:10.3760/cma.j.issn.1004-4221.2015.03.011.
2017, Vol. 26 
