| Background and purpose:Nasopharyngeal carcinoma is a relatively high incidence rate of malignancy in southern China.Most of the cases are concentrated in Guangdong,Guangxi,Hunan and Fujian.It is more common in middle-aged men,40-60 years old.The histological types(WHO classification)of NPC can be roughly divided into three types: keratinized squamous cell carcinoma,non keratinized carcinoma and undifferentiated carcinoma.Among them,squamous cell carcinoma with low differentiation is the most common,accounting for 80%.In recent years,with the progress of technology and in-depth research,the treatment plan of nasopharyngeal carcinoma is constantly optimized,forming a treatment mode combining radiotherapy,chemotherapy,targeted treatment and other treatment methods.The overall 5-year survival rate of nasopharyngeal carcinoma is 70%.However,because the disease is prone to lymph node metastasis,which not only affects the stage and treatment of NPC,but also affects the prognosis.In this paper,the effect of regional lymph node metastasis on the prognosis of NPC was studied.Materials and Methods:From 2012 to 2018,we analyzed the clinical data of 114 NPC patients with no distant metastasis who were first diagnosed and treated in our Hospital,reviewed the MR or PET-CT images of each patient before treatment,counted the patients’ retropharyngeal lymph node and cervical lymph node metastasis and recorded the objective characteristics.The short-term efficacy of each patient was evaluated according to the RECIST evaluation criteria.SPSS 20.0 software was used to analyze the related factors of lymph node metastasis by chi square test,and log rank test was used to analyze the prognosis of NPC after radiotherapy.P < 0.05 was statistically significant.Results: 1.Related factors of lymph node metastasisAmong 114 patients,98(86%)had regional lymph node metastasis(including retropharyngeal lymph node and cervical lymph node),98(86.0%)had lymph node metastasis,21(21.4%)had zone I lymph node metastasis,89(90.8%)had zone II lymph node metastasis,48(49.0%)had zone III lymph node metastasis,and 10(10.2%)had Zone IV lymph node metastasis There were 12 cases(12.2%)with lymph node metastasis in area V,80 cases(81.6%)with retropharyngeal lymph node metastasis,and no patients with lymph node metastasis in area VI.There were 4 cases of regional lymph node metastasis in Area III or IV without area II metastasis,and 0 cases in Area IV without Area III metastasis.The frequency of leaping metastasis was 3.5% in 4 cases.Among the patients with lymph node metastasis,14(14.3%)had one lymph node metastasis,84(85.7%)had two or more.Among the patients with lymph node metastasis,76(77.6%)had the largest lymph node size < 3 cm,22(22.4%)had the largest lymph node size ≥ 3 cm.There was no significant difference in the incidence of lymph node metastasis between patients of different ages(c2= 3.707,P = 0.054).There was no significant difference in the incidence of lymph node metastasis between patients of different genders(c2= 0.266,P = 0.606).There was no significant difference in the incidence of lymph node metastasis between early local(T1-2)and late local(T3-4)(c2= 0.56,P = 0.454)2.Analysis of the short-term effect of lymph node metastasis on nasopharyngeal carcinoma after radiotherapyAmong the 114 patients,58 had complete remission(CR),54 had partial remission(PR),and 2 had stable disease(SD).There was no disease progression.The total disease remission rate was 98.2%(112 / 114).The short-term curative effect(CR)accounted for 50.9%.For different sex,age group,T stage,TNM stage,N stage,the CR rate of disease was analyzed.The results showed that there was significant difference in CR rate of different TNM and N stages(P < 0.05).To further explore the number,size and number of lymph node metastasis sides in patients with lymph node metastasis,as well as whether there are areas I,II,III,IV,V and retropharyngeal lymph node metastasis that affect the CR rate of the disease.The results showed that there was a significant difference in CR rate between the size and number of metastatic lymph nodes(P < 0.05)3.Long term survival of lymph node metastasis after radiotherapy for nasopharyngeal carcinomaThe median survival time of 114 patients was 47.7 months,and the OS rate of 3 and 5 years was 82.5%(94 cases)and 77.2%(88 cases),respectively.3.The 5-year DMFS rate was 87.7%(100 cases)and 85.1%(97 cases),respectively.3.The LRFS in 5 years were 93.0%(106 cases)and 91.2%(104 cases),respectively.In the past 5 years,17 cases had distant metastasis,the most common site of metastasis was bone(7 cases,41%).Other sites of metastasis were more common in lung,liver,brain and so on.Whether there was regional lymph node metastasis had an effect on OS and DMFS in 5 years,the difference was statistically significant(P = 0.02,P = 0.007),and had no effect on LRFS(P = 0.985).The number,size and number of lymph node metastasis sides in patients with lymph node metastasis,and the presence or absence of lymph node metastasis in area I,II,III,IV,V and retropharyngeal were analyzed by single factor analysis.The results showed that the difference of OS in 5 years in patients with different lymph node sizes was statistically significant(P = 0.006).The difference of DMFS in 5 years was statistically significant(P < 0.05).The difference of LRFS in patients with lymph node metastasis in area I was statistically significant(P = 0.036).Conclusion:1.NPC is prone to lymph node metastasis.The incidence of lymph node metastasis has nothing to do with age,gender and T stage.At the same time,the lymph node metastasis of NPC follows the order from top to bottom,with less jumping metastasis.2.Whether there is lymph node metastasis,the size and number of lymph nodes have influence on the short-term curative effect of CR.3.Regional lymph node metastasis is the influencing factor of total survival and distant metastasis.The specific characteristics of lymph nodes,such as single and double sides,size and number,are the prognostic factors of distant metastasis of NPC. |
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