Head and Neck Cancer
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s): To evaluate the prognostic value of magnetic resonance imaging (MRI)-determined lymph nodal necrosis (LNN) in patients with nasopharyngeal carcinoma (NPC) and further explored the feasibility of an N-classification system based on the 8th edition of the American Joint Committee on Cancer (AJCC) system.
Materials/Methods: The MRI scans of 616 patients with newly diagnosed stage T1, 4N1, 3M0 NPC treated with definitive intensity-modulated radiotherapy (IMRT) were reviewed retrospectively.
Results: The incidence of LNN was 38.1% (235 of 616). Multivariate analysis showed that LNN was an independent prognostic predictor of distant metastasis free survival and overall survival. The survival outcomes for patients with classification N2 disease and LNN were similar to patients with classification N3 disease. Patients with classification N1 disease and LNN had similar survival outcomes as those with stage N2 disease without LNN. Patients of classification N1 disease with LNN were reclassified as classification N2, and classification N2 disease with LNN as classification N3 in the proposed N-classification system. Correlation with death and distant failure was significant, and the total difference between N1 and N3 was wider with the proposed system. The overall distribution pattern of the proposed N-classification was more equitable than that of the 8th AJCC N-classification.
Conclusion: MRI-determined LNN is an independent prognostic factor for NPC treated by IMRT. The proposed N classification system with MRI-determined LNN based on the 8th AJCC system is powerfully predictive.
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