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Nodal grouping in nasopharyngeal carcinoma: prognostic significance, N classification, and a marker for the identification of candidates for induction chemotherapy

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Abstract

Objectives

This study aimed to evaluate the value of nodal grouping (NG), defined as the presence of at least three contiguous lymph nodes (LNs) within one LN region, in staging and management of patients with non-metastatic nasopharyngeal carcinoma (NPC).

Methods

MR images were reviewed to evaluate LN variables, including NG. The Kaplan–Meier method and multivariate Cox regression models evaluated the association between the variables and survival. Harrell’s concordance index (C-index) was used to measure the performance of prognostic models. The outcome of induction chemotherapy (IC) in patients with and without NG was compared using matched-pair analysis.

Results

In 1224 patients enrolled, NG was found to be an independent prognostic factor for overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and regional recurrence-free survival. The hazard ratio and 95% confidence interval (CI) of NG for OS (3.86, 2.09–7.12) were higher than those of stage N2 (3.54, 1.89–6.70). On upgrading patients with NG from stages N1 to N2, the revised N staging yielded a higher C-index compared to the American Joint Committee on Cancer system in predicting PFS (0.664 vs. 0.658, p = 0.022) and DMFS (0.699 vs. 0.690, p = 0.005). Results of the matched-pair analysis revealed that for patients with NG in stages N1 and N2, IC was correlated with improved OS (p = 0.022), PFS (p = 0.007), and DMFS (p = 0.021).

Conclusions

NG is a significant prognostic factor for patients with NPC. Patients with NG may be upgraded from stages N1 to N2. NG was also a marker for identifying patients who would benefit from IC.

Key Points

• Nodal grouping, defined as the presence of at least three contiguous LNs within one LN region on MRI, was identified as a significant prognostic factor.

• In patients with nasopharyngeal carcinoma, nodal grouping may influence lymph node staging.

• Nodal grouping was a marker for identifying patients who may benefit from induction chemotherapy.

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Abbreviations

AJCC:

American Joint Committee on Cancer

C-index:

Harrell’s concordance index

CCRT:

Concurrent chemoradiotherapy

CI:

Confidence interval

CNN:

Central nodal necrosis

DMFS:

Distant metastasis-free survival

EBV:

Epstein–Barr virus

ENS:

Extracapsular nodal spread

FSE:

Fast spin-echo

HR:

Hazard ratio

IC:

Induction chemotherapy

IMRT:

Intensity-modulated radiation therapy

LN:

Lymph node

MD:

Maximal diameter

MID:

Minimal axial diameter

NG:

Nodal grouping

NPC:

Nasopharyngeal carcinoma

OS:

Overall survival

PFS:

Progression-free survival

RRFS:

Regional recurrence-free survival

T1WI :

1-weighted images

T2WI:

T2-weighted images

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Funding

This study was supported by Grant No. 61771007 from the National Natural Science Foundation of China; Grant No. 201907010043 from the Science and Technology Planning Project of Guangzhou City, China; Grant No. 703040078088 from the Science and Technology Development Special Funds (Frontier and Key Technology Innovation Direction – Major Science and Technology Project) of Guangdong Province; and Grant No. 201803010021 from the Health & Medical Collaborative Innovation Project of Guangzhou City.

Author information

Author notes

  1. Yifei Liu and Shenghuan Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People’s Republic of China

    Yifei Liu, Annan Dong, Fei Ai, Tingting Quan, Chunyan Cui, Jian Zhou, Shuoyu Xu, Haojiang Li & Lizhi Liu

  2. Department of Radiology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, People’s Republic of China

    Shenghuan Chen

  3. Department of Radiation Oncology, First People’s Hospital of Foshan, Foshan, People’s Republic of China

    Shaobo Liang

  4. School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China

    Jiamin Wang & Ling Hua

  5. Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People’s Republic of China

    Shunxin Wang

  6. Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China

    Mingyuan Chen

  7. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China

    Ying Sun

Authors
  1. Yifei Liu
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  16. Lizhi Liu
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Corresponding authors

Correspondence to Haojiang Li or Lizhi Liu.

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The scientific guarantor of this publication is Lizhi Liu.

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The authors declare that they have conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the institutional review board.

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Institutional review board approval was obtained.

Methodology

• retrospective

• observational

• multicenter study

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Liu, Y., Chen, S., Dong, A. et al. Nodal grouping in nasopharyngeal carcinoma: prognostic significance, N classification, and a marker for the identification of candidates for induction chemotherapy. Eur Radiol 30, 2115–2124 (2020). https://doi.org/10.1007/s00330-019-06537-6

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  • DOI: https://doi.org/10.1007/s00330-019-06537-6

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