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European Radiology
Published in: European Radiology 11/2022

18-04-2022 | Metastasis | Head and Neck

Prognostic value of quantitative cervical nodal necrosis burden on MRI in nasopharyngeal carcinoma and its role as a stratification marker for induction chemotherapy

Authors: Jiao Li, Qin Zhao, Yun Zhang, Haojiang Li, Guangying Ruan, Lizhi Liu, Yue Yan, Chunyan Cui

Published in: European Radiology | Issue 11/2022

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Abstract

Objectives

This study aimed to assess the prognostic value of quantitative cervical nodal necrosis (CNN) burden in N staging risk stratification in patients with nasopharyngeal carcinoma.

Methods

Univariate and multivariate Cox regression models evaluated the association between lymph node variables based on MRI images and survival. Revisions for the N classification system were proposed and compared to the 8th edition AJCC staging system using Harrell’s concordance index (C-index). The survival outcomes of induction chemotherapy plus concurrent chemoradiotherapy (CCRT) and CCRT alone in patients with multiple CNNs were compared.

Results

In 1319 patients enrolled, CNN was not an independent prognostic factor for the main survival outcomes, but multiple CNNs (three or more necrotic nodes) were independent prognostic factors for distant metastasis-free survival (DMFS) (adjusted hazard ratio [HR], 2.05; p = 0.020) and progression-free survival (PFS) (HR, 1.78; p = 0.004), surpassing other nodal variables. On upgrading patients with multiple CNNs to revised N3 disease, the proposed N staging widened the differences in DMFS and PFS between N2 and N3 disease. The overall survival of patients with multiple CNNs who received CCRT plus induction chemotherapy was improved compared to that of those who received CCRT alone (76.1% vs. 55.7%; adjusted p = 0.030).

Conclusions

Upgrading patients with multiple CNNs to stage N3 may improve prognostication of the current AJCC staging system. Multiple CNNs might be a potential marker for stratifying patients who would benefit from induction chemotherapy.

Key Points

• Quantitatively assessed the prognostic value of CNN burden in patients with NPC.
• Upgrading patients with multiple CNNs to stage N3 may improve prognostication.
• Multiple CNNs may be used as a stratification marker for induction chemotherapy.
Appendix
Available only for authorised users
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Metadata
Title
Prognostic value of quantitative cervical nodal necrosis burden on MRI in nasopharyngeal carcinoma and its role as a stratification marker for induction chemotherapy
Authors
Jiao Li
Qin Zhao
Yun Zhang
Haojiang Li
Guangying Ruan
Lizhi Liu
Yue Yan
Chunyan Cui
Publication date
18-04-2022
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-022-08785-5

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