| Objective:By analyzing the clinical data of parotid gland lymph node metastasis in newly diagnosed nasopharyngeal carcinoma,the effect of parotid gland lymph node on the prognosis of nasopharyngeal carcinoma and its attribution in the staging of nasopharyngeal were discussed.Methods:We retrospectively collected clinical data of 875 patients with non-metastatic nasopharyngeal carcinoma who were confirmed by nasopharyngeal biopsy in the first diagnosis of Jiangxi Province Cancer Hospital from January 2010 to December 2013.Pearson chi-square test method was used to study the correlation between parotid lymph node metastasis and staging.Kaplan-meier method was used to calculate survival rate.Logrank performed a significant test on the difference in survival rate.COX proportional hazards regression model was used for multivariate analysis Determine the independent prognostic factors and calculate the risk value.All tests are bilateral and P <0.05 is statistically significant.Results:1.Characteristics of parotid lymph node metastasis: A total of 19 patients developed parotid lymph node metastasis with an incidence rate of 2.2%.All were unilateral metastases,and the number of lymph node metastases in the superficial parotid and deep groups was 16(84.2%)and 8(42.1%),respectively;17(89.5%)were on the same side as nasopharyngeal tumors,15(78.9%)Ipsilateral parapharyngeal space invasion,17 cases of retropharyngeal lymph node metastasis,all with level II lymph node metastasis;16 cases(84.2%)had level II lymph node extracapsular invasion,and 18(94.7%)cases had level II lymph node necrosis;The maximum axial diameter of level II lymph nodes is 5.5 ± 1.7cm;11(57.9%)cases of cervical lymph node metastasis are located in the upper neck.2.Correlation between parotid lymph nodes and staging: Univariate analysisshowed that parotid lymph node metastasis was associated with N stage and total stage(P = 0.001,P = 0.04),but not with T stage(P = 0.37).And the incidence of parotid lymph node metastasis in patients with N3 and IVb is significantly higher than that in patients with N0-2 and I-IVa,both of which are statistically significant.(7.4% vs1.2%,P <0.001;7.4% vs 1.2%,P <0.001)3.Prognostic analysis of parotid lymph nodes: Univariate survival analysis showed that parotid lymph node metastasis was the influencing factor of DMFS and PFS(P <0.001,P <0.001),not the influencing factors of OS,LRFS and RRFS(P =0.103,P = 0.473,P = 0.272).multivariate COX regression analysis found that parotid lymph node metastasis was an independent prognostic factor for DMFS and PFS(P =0.03,HR = 2.287,95% CI 1.083-4.828;P = 0.027,HR = 2.195 95% CI 1.092-4.412).4.Discussion on the attribution of parotid lymph nodes in nasopharyngeal carcinoma staging: The curves of the PLNM(+)group and the curves of the N0 + N1,N2,and N3 groups can be pulled apart and have statistical significance(all P <0.001).Compared with patients in group N3,patients with PLNM(+)group had a significantly higher risk of distant metastasis and progression,all with statistical significance(P <0.001,HR = 11.660,95% CI 4.914-27.666;P <0.001,HR = 8.69295% CI 4.005-18.862).Conclusion:Newly diagnosed nasopharyngeal carcinoma has low rate of parotid lymph node metastasis and is often associated with high neck tumor burden.Patients with stage N3 and IVb are more prone to lymph node metastasis.Compared with N3 disease,they have a higher risk of distant metastasis and disease progression.The staging may be similar to M1 disease,but it still needs to be further explored. |
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