By MRI To Investigate The Prognostic Value Of Cervical Matted Nodes In Patients With Nasopharyngeal Carcinoma

Purpose:To explore the prognostic value of cervical matted nodes(MNs) in patients with nasopharyngeal carcinoma(NPC) according to magnetic resonance(MR) imaging. Materials and Methods:This was a retrospective study of 390 patients with newly diagnosed stage T1-4N1-3M0 NPC in our hospital Radiation Oncology, between January 2008 and June 2010. MR images were reviewed to assess lymph node status, and patients were divided into non-MNs and MNs groups. The overall survival(OS), progression-free survival(PFS), distant metastasis–free survival(DMFS) and regional relapse-free survival(RRFS) were analyzed by the Kaplan-Meier method and differences between groups were compared by using the log-rank test. Multivariable analyses were estimated by using the Cox proportion hazards model. Statistical significance was defined as P value ? 0.05.The incidence of cervical MNs was 26.4%(103/390). The median follow-up time was 57 months(range, 3–84 months), the 3-year OS, PFS,DMFS and RRFS rates of the non-MNs and MNs groups were 81.1% and 61.4%, 79.9% and 47.4%, 84.8% and 60.6%, 95.7% and 80.0%, respectively(for all rates, log-rank P ? 0.001). The cumulative rate of distant metastasis was 21.8% and 43.9%for the non-MNs group and MNs group(log-rank, P ? 0.001). Subgroup analysis revealed the survival outcomes of the two groups were statistical significance in patients with stage N1 and N2 disease. However, not in N3 stage. Stage N1 with MNs disease and stage N2 with non-MNs disease had similar survival outcomes, stage N2 with MNs disease and stage N3 disease, as well. Radiotherapy alone compared with chemoradiotherapy, the 3-year OS, PFS, DMFS and RRFS rates of the whole group were 65.3% and 80.6%(log-rank, P ? 0.001), 61.5% and 75.2%(P = 0.005), 69.7% and 82.4%(P = 0.014), 87.4% and 94.4%(P = 0.021), respectively, and In MNs group, the 3-year OS, PFS, DMFS and RRFS rates were 42.4% and 70.6%(P = 0.002), 39.2% and 51.1%(P = 0.049), 41.6% and 68.1%(P = 0.035), 72.2% and 86.1%(P = 0.002), respectively. MNs, KPS score ? 80, age older than 50 year, T3-4 stage, N stage, and radiotherapy alone were significant independent adverse prognostic factors for OS, PFS, DMFS and RRFS. Conclusion:Cervical MNs is an independent adverse prognostic factor in patients with NPC, and it may be advisable to consider whether N stage with MNs should be upgraded by one level.