AbstractObjective To explore the relationship between positive cervical lymph nodes and distant metastasis after intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC). Methods A retrospective analysis was performed on the clinical data of 474 patients who were newly diagnosed with NPC but no distant metastasis and received IMRT from 2010 to 2012. The survival rates were calculated by the Kaplan-Meier method. The log-rank test was used for comparison of survival rates and univariate prognostic analysis. The multivariate analysis was made by the Cox regression model. Results In the 474 patients, 400 had positive cervical lymph nodes and 122 had residual masses in the neck after IMRT. The four-year distant metastasis, overall survival, disease-free survival, local relapse-free survival, and distant metastasis-free survival (DMFS) rates were 13.71%(65/474), 82.9%, 81.4%, 93.5%, and 86.3%, respectively. The univariate and multivariate analyses showed that treatment approach, lymph node metastases in lower neck Ⅳ/Ⅴb/Ⅴc regions, the greatest diameter of the positive cervical lymph nodes, the diameter of residual lymph nodes, and time to lymph node recession were independent prognostic factors for DMFS (all P<0.05). Conclusions Chemoradiotherapy can reduce the distant metastasis rate after IMRT for NPC. The larger the cervical lymph nodes are, the more likely there are residual masses;the larger the residual cervical lymph nodes are, the higher risk of distant metastasis there is. Large cervical lymph nodes (≥6 cm), residual masses larger than 1 cm, and residual masses at 3 months after IMRT are negative prognostic factors for DMFS after IMRT for NPC. Better intervention treatment approaches need to be explored.
Fund:National Natural Science Foundation of China (81460460)
Corresponding Authors:
Wang Rensheng,Email:13807806008@163.com
Cite this article:
Liao Xueyin,Kang Min,Xu Meng et al. Relationship between positive lymph nodes and distant metastasis after intensity-modulated radiotherapy in patients with nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2017, 26(12): 1359-1364.
Liao Xueyin,Kang Min,Xu Meng et al. Relationship between positive lymph nodes and distant metastasis after intensity-modulated radiotherapy in patients with nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2017, 26(12): 1359-1364.
[1] Mao YP,Tang LL,Chen L,et al. Prognostic factors and failure patterns in non-metastatic nasopharyngeal carcinoma after intensity-modulated radiotherapy[J].Chin J Cancer,2016,35(1):103.DOI:10.1186/s40880-016-0167-2. [2] Guigay J,Temam S,Bourhis J,et al. Nasopharyngeal carcinoma and therapeutic management:the place of chemotherapy[J].Ann Oncol,2006,17 Suppl 10:x304-x307.DOI:10.1093/annonc/mdl278. [3] 林灿峰,李东升,辛淑波,等.鼻咽癌治疗后远处转移模式分析[J].广东医学,2014,35(5):743-745.DOI:10.13820/j.cnki.gdyx.2014.05.042. Lin XF,Li DS,Xin SB,et al. Model analysis of distant metastasis of nasopharyngeal carcinoma after treatment[J].Guangdong Med J,2014,35(5):743-745.DOI:10.13820/j.cnki.gdyx.2014.05.042. [4] Grégoire V,Ang K,Budach W,et al. Delineation of the neck node levels for head and neck tumors:a 2013 update. DAHANCA,EORTC,HKNPCSG,NCIC CTG,NCRI,RTOG,TROG consensus guidelines[J].Radiother Oncol,2014,110(1):172-181.DOI:10.1016/j.radonc.2013.10.010. [5] Edge SB,Compton CC.The American joint committee on cancer:the 7th edition of the AJCC cancer staging manual and the future of TNM[J].Ann Surg Oncol,2010,17(6):1471-1474.DOI:10.1245/s10434-010-0985-4. [6] 中国鼻咽癌临床分期工作委员会.2010鼻咽癌IMRT靶区及剂量设计指引专家共识[J].中华放射肿瘤学杂志,2011,20(4):267-269.DOI:10.3760/cma.j.issn.1004-4221.2011.04.001.Chinese nasopharyngeal carcinoma staging Committee. The consensus 2010 nasopharyngeal carcinoma IMRT target and dose expert design guidelines[J].Chin J Radiat Oncol,2011,20(4):267-269.DOI:10.3760/cma.j.issn.1004-4221.2011.04.001. [7] 韩露,林少俊,潘建基,等.305例鼻咽癌IMRT预后因素分析[J].癌症,2010,29(2):153-158. Han L,Lin SJ,Pan JJ,et al. Prognostic factors of 305 nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy[J].Chin J Cancer,2010,29(2):153-158. [8] Sun XM,Su SF,Chen CY,et al. Long-term outcomes of intensity-modulated radiotherapy for 868 patients with nasopharyngeal carcinoma:an analysis of survival and treatment toxicities[J].Radiother Oncol,2014,110(3):398-403.DOI:10.1016/j.radonc.2013.10.020. [9] Tan WL,Tan EH,Lim DW,et al. Advances in systemic treatment for nasopharyngeal carcinoma[J].Chin Clin Oncol,2016,5(2):21.DOI:10.21037/cco.2016.03.03. [10] Chua DTT,Ma J,Sham JST,et al. Improvement of survival after addition of induction chemotherapy to radiotherapy in patients with early-stage nasopharyngeal carcinoma:subgroup analysis of two Phase Ⅲ trials[J].Int J Radiat Oncol Biol Phys,2006,65(5):1300-1306.DOI:10.1016/j.ijrobp.2006.02.016. [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] 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 in nasopharyngeal carcinoma?[J].Radiother Oncol,2014,113(1):108-114.DOI:10.1016/j.radonc.2014.08.036. [13] Tang LL,Guo R,Zhou GQ,et al. Prognostic value and staging classification of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy[J].PLoS One,2014,9(10):e108375.DOI:10.1371/journal.pone.0108375. [14] Shi Q,Shen CY,Kong L,et al. Involvement of both cervical lymph nodes and retropharyngeal lymph nodes has prognostic value for N1 patients with nasopharyngeal carcinoma[J].Radiat Oncol,2014,9:7.DOI:10.1186/1748-717X-9-7. [15] Yao JJ,Lin L,Jin YN,et al. Prognostic value of serum Epstein-Barr virus antibodies in patients with nasopharyngeal carcinoma and undetectable pretreatment Epstein-Barr virus DNA[J].Cancer Sci,2017,108(8):1640-1647.DOI:10.1111/cas.13296. [16] Zhang J,Shu C,Song YL,et al. Epstein-Barr virus DNA level as a novel prognostic factor in nasopharyngeal carcinoma:a meta-analysis[J].Medicine (Baltimore),2016,95(40):e5130.DOI:10.1097/MD.0000000000005130. [17] 廖瑜露,汤轶强,舒禹先,等.鼻咽癌IMRT后残留及解救治疗对预后的影响[J].广东医学,2016,37(7):1042-1045.DOI:10.13820/j.cnki.gdyx.2016.07.023. Liao YL,Tang YQ,Shu YX,et al. The residue and rescue therapy on the prognosis of nasopharyngeal carcinoma after IMRT[J].Guangdong Med J,2016,37(7):1042-1045.DOI:10.13820/j.cnki.gdyx.2016.07.023. [18] 朱成斌,古丽娜尔·吐尔地.颈部淋巴结残留对鼻咽癌放疗患者远期生存情况的影响[J].医学临床研究,2016,33(8):1662-1664.DOI:10.3969/j.issn.1671-7171.2016.08.076. Zhu CB,Gulinal·Turdi. Effect of residual cervical lymph nodes on long-term survival in patients with nasopharyngeal carcinoma after radiotherapy[J].J Clin Res,2016,33(8):1662-1664.DOI:10.3969/j.issn.1671-7171.2016.08.076. [19] 韩非,王汉渝,黄莹,等.适形调强放射治疗对鼻咽癌退缩方式的影响[A]//第六届全国鼻咽癌学术大会论文汇编[C].天津:中国抗癌协会,2010:11. Han F,Wang HY,Huang Y,et al. IMRT withdrawal way in nasopharyngeal carcinoma[A]//The Sixth National Academic Conference Proceedings of the NPC[C].Tianjin:Chinese Anti-Cancer Association,2010:11. [20] Zhang N,Liang SB,Deng YM,et al. Primary tumor regression speed after radiotherapy and its prognostic significance in nasopharyngeal carcinoma:a retrospective study[J].BMC Cancer,2014,14:136.DOI:10.1186/1471-2407-14-136. [21] Lin GW,Wang LX,Ji M,et al. The use of MR imaging to detect residual versus recurrent nasopharyngeal carcinoma following treatment with radiation therapy[J].Eur J Radiol,2013,82(12):2240-2246.DOI:10.1016/j.ejrad.2013.09.014. [22] 王茂鑫,陈辉,陈贤明,等.鼻咽癌放疗后颈部淋巴结残留或复发对预后的影响[J].中国耳鼻咽喉头颈外科,2014,21(9):457-460. Wang MX,Chen H,Chen XM,et al. Effect of residual or recurrent cervical lymph node on prognosis of the nasopharyngeal cancer after radiotherapy[J].Chin Arch Otolaryngol Head Neck Surg,2014,21(9):457-460. [23] 李思维,赵博,张荣君,等.鼻咽癌远处转移研究的进展[J].医学综述,2014,20(6):1020-1022.DOI:10.3969/j.issn.1006-2084.2014.06.021. Li SW,Zhao B,Zhang RJ,et al. The research development of nasopharyngeal carcinoma with distant metastasis[J].Med Recapitul,2014,20(6):1020-1022.DOI:10.3969/j.issn.1006-2084.2014.06.021. [24] 袁军,郭海亮,许明君,等.分段优化方法在鼻咽癌调强计划中的应用[J].临床医学工程,2013,20(11):1330-1332.DOI:10.3969/j.issn.1674-4659.2013.11.1330. Yuan J,Guo HL,Xu MJ,et al. Application of piecewise optimization methods used in nasopharyngeal carcinoma intensity modulated plan design[J].Clin Med Eng,2013,20(11):1330-1332.DOI:10.3969/j.issn.1674-4659.2013.11.1330. [25] 傅敏仪,叶飞,陈国平,等.鼻咽癌放疗后颈部淋巴结残留和复发的分布及处理[J].现代肿瘤医学,2014,22(12):2824-2826.DOI:10.3969/j.issn.1672-4992.2014.12.16. Fu MY,Ye F,Chen GP,et al. Distribution and management of recurrent and persistent lymph node of nasopharyngeal carcinoma after radiotherapy[J].J Mod Oncol,2014,22(12):2824-2826.DOI:10.3969/j.issn.1672-4992.2014.12.16.
2017, Vol. 26 
