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

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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.

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Abbreviations

AJCC:

American Joint Committee on Cancer

CCRT:

Concurrent chemoradiotherapy

CNN:

Cervical nodal necrosis

DMFS:

Distant metastasis-free survival

EBV:

Epstein-Barr virus

ENS:

Extranodal neoplastic spread

LN:

Lymph node

NPC:

Nasopharyngeal carcinoma

PFS:

Progression-free survival

RFS:

Recurrence-free survival

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Acknowledgements

We would like to thank Editage (www.editage.com) for their writing support.

Funding

This work was supported by the Key-Area Research and Development of Guangdong Province (2020B1111190001); Science and Technology Planning Project of Guangzhou City, China [Grant No. 201907010043].

Author information

Author notes

  1. Jiao Li, Qin Zhao and Yun Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Imaging, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People’s Republic of China

    Jiao Li, Qin Zhao, Yun Zhang, Haojiang Li, Guangying Ruan, Lizhi Liu & Chunyan Cui

  2. Department of Radiology, The Third People’s Hospital of Shenzhen, Shenzhen, Guangdong, 518000, People’s Republic of China

    Lizhi Liu

  3. Cancer Prevention Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, People’s Republic of China

    Yue Yan

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Corresponding authors

Correspondence to Yue Yan or Chunyan Cui.

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Guarantor

The scientific guarantor of this publication is Lizhi Liu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Radiotherapy and Oncology and European Radiology.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Li, J., Zhao, Q., Zhang, Y. et al. Prognostic value of quantitative cervical nodal necrosis burden on MRI in nasopharyngeal carcinoma and its role as a stratification marker for induction chemotherapy. Eur Radiol 32, 7710–7721 (2022). https://doi.org/10.1007/s00330-022-08785-5

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  • DOI: https://doi.org/10.1007/s00330-022-08785-5

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