High-risk factors of retropharyngeal lymph node metastasis in patients with hypopharyngeal carcinoma based on magnetic resonance imaging
Wang Huili, Qu Yuan, Wang Kai, Wu Runye, Liu Qingfeng, Zhang Ye, Zhang Shiping, Xiao Jianping, Yi Junlin, Gao Li, Xu Guozhen, Luo Jingwei, Huang Xiaodong
Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Abstract：Objective To analyze the incidence and high-risk factors of lymph node metastasis in the retropharyngeal region of hypopharyngeal squamous cell carcinoma based on magnetic resonance imaging (MRI), aiming to guide the delineation of clinical target area. Methods Clinical data of patients who were pathologically diagnosed with hypopharyngeal carcinoma from January 2012 to September 2018 in our center were retrospectively analyzed. All patients received head and neck MRI before treatment. The diagnosis of lymph node metastasis and the delineation of primary gross target volume (GTVp) and lymph nodes target volume (GTVnd) were determined by all the radiation oncologists in head and neck group through twice weekly general round discussion. The cut-off points of GTVp and GTVnd were defined by establishing the receiver operating characteristic curve. All patients were divided into the high GTVp, low GTVp and high GTVnd and low GTVnd groups. Chi-square test was used for univariate analysis and logistic regression was utilized for multivariate analysis to analyze the high-risk factors of patients with retropharyngeal lymph node metastasis. Results A total of 326 patients were included in this study, 295 of whom were diagnosed with cervical lymph node metastasis, accounting for 90.5%. The most common involved area was Level Ⅱ a, followed by Level Ⅲ, Level Ⅱ b, Level IV, Level Ⅶ a (retropharyngeal), Level V a, and Level V b. The incidence of retropharyngeal lymph node metastasis was 21.5%, and the incidence was 53.1% in patients with primary tumor located in the posterior pharyngeal wall. Univariate and multivariate analyses showed that patients with tumor originated from the posterior pharyngeal wall (P=0.002), bilateral cervical lymph node metastasis (P=0.020), larger GTVp (greater than 47 cm3,P=0.003), and larger GTVnd (greater than 22 cm3, P=0.023) were significantly associated with the occurrence of retropharyngeal lymph node metastasis. Conclusions The incidence of retropharyngeal lymph node metastasis is high in hypopharyngeal carcinoma, especially in patients with primary tumors in the posterior pharyngeal wall, bilateral cervical lymph node metastasis and larger primary burden. Therefore, for patients with these risk factors, it is highly recommended that the clinical target area should be delineated to include the retropharyngeal lymph node drainage area.
Wang Huili,Qu Yuan,Wang Kai et al. High-risk factors of retropharyngeal lymph node metastasis in patients with hypopharyngeal carcinoma based on magnetic resonance imaging[J]. Chinese Journal of Radiation Oncology, 2020, 29(8): 625-628.
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2020, Vol. 29 
