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MRI-identified multidimensional nodal features predict survival and concurrent chemotherapy benefit for stage II nasopharyngeal carcinoma

Radiology and Oncology
Volume 56 (2022): Issue 4 (December 2022)
By:
Open Access
|Dec 2022

Figures & Tables

Figure 1

Axial T1-weighted fat-suppressed contrast MRI images of grade 0–2 extranodal extension (ENE) in four stage II nasopharyngeal carcinoma patients. (A) Grade 0: without ENE; (B) Grade 1: lymph node (LN) infiltrating surrounding fat; (C) Grade 2: matted LNs; and (D) Grade 3: LN infiltrating sternocleidomastoid muscle (wight arrows).
Axial T1-weighted fat-suppressed contrast MRI images of grade 0–2 extranodal extension (ENE) in four stage II nasopharyngeal carcinoma patients. (A) Grade 0: without ENE; (B) Grade 1: lymph node (LN) infiltrating surrounding fat; (C) Grade 2: matted LNs; and (D) Grade 3: LN infiltrating sternocleidomastoid muscle (wight arrows).

Figure 2

Multidimensional nodal features of stage II nasopharyngeal carcinoma significantly associated with survival outcomes in univariate or multivariate analysis. Axial T2-weighted fat-suppressed image of (A) a 24-year-old man with one lymph nodes (LN) in level III; (B) a 56-year-old man with maximum diameter of lymph node 3.3cm; (C) a 50-year-old woman with four metastatic LNs; and (D) Sagittal T1-weighted fat-suppressed contrast images of a 45-year-old woman showing central nodal necrosis (CNN) (wight arrows). MAD = maximal axial diameter
Multidimensional nodal features of stage II nasopharyngeal carcinoma significantly associated with survival outcomes in univariate or multivariate analysis. Axial T2-weighted fat-suppressed image of (A) a 24-year-old man with one lymph nodes (LN) in level III; (B) a 56-year-old man with maximum diameter of lymph node 3.3cm; (C) a 50-year-old woman with four metastatic LNs; and (D) Sagittal T1-weighted fat-suppressed contrast images of a 45-year-old woman showing central nodal necrosis (CNN) (wight arrows). MAD = maximal axial diameter

Figure 3

Nomogram and calibration plots of 5- and 10-year overall survival (OS). Number of positive lymph nodes was as continuous variable.
Nomogram and calibration plots of 5- and 10-year overall survival (OS). Number of positive lymph nodes was as continuous variable.

Figure 4

Comparison of (A) area under the curve (AUC) plots, decision curves of (B) 5-year overall survival (OS) and (C) 10-year OS between the nomogram and TNM stage.
Comparison of (A) area under the curve (AUC) plots, decision curves of (B) 5-year overall survival (OS) and (C) 10-year OS between the nomogram and TNM stage.

Figure 5

Survival curves of the (A–D) three subgroups in American Joint Committee on Cancer staging system (AJCC), TNM staging and (E–H) the low- and high-risk groups stratified by the nomogram-derived score.
Survival curves of the (A–D) three subgroups in American Joint Committee on Cancer staging system (AJCC), TNM staging and (E–H) the low- and high-risk groups stratified by the nomogram-derived score.

Figure 6

Impact of concurrent
Impact of concurrent

Figure 7

The 5-year and 10-year overall survival (OS) rates and hazard ratio (HR) between intensity-modulated radiotherapy (IMRT) group and concurrent chemoradiotherapy (CCRT) group according to (A) TNM staging system and (B) prognostic risk model.
The 5-year and 10-year overall survival (OS) rates and hazard ratio (HR) between intensity-modulated radiotherapy (IMRT) group and concurrent chemoradiotherapy (CCRT) group according to (A) TNM staging system and (B) prognostic risk model.

Characteristics of 242 patients with stage II nasopharyngeal carcinoma

CharacteristicsNo. (%)
Age, median (range)50 (18–76)
< 50120 (49.6)
≥ 50122 (50.4)
Sex
Male173 (71.5)
Female69 (28.5)
AJCC 8th T stage
T1104 (43.0)
T2138 (57.0)
AJCC 8th N stage
N030 (12.4)
N1212 (87.6)
AJCC 8th subgroup
T1N1M0104 (43.0)
T2N0M031 (12.8)
T2N1M0107 (44.2)
GTVnx volume (cm3), median (range)19.1 (2.1–74.0)
< 13.770 (28.9)
≥ 13.7172 (71.1)
GTVnd volume (cm3), median (range)8.7 (0–71.0)
< 29.1212 (87.6)
≥ 29.130 (12.4)
Lateral of RPLNs
None90 (37.2)
Unilateral113 (46.7)
Bilateral39 (16.1)
LN located in level III
Yes195 (80.6)
No47 (19.4)
LN size (cm)1.7 (0–6.0)
MAD < 2.2152 (62.8)
MAD ≥ 2.290 (37.2)
Number of positive LN2 (0– 9)
030 (12.4)
169 (28.5)
260 (24.8)
351 (21.1)
419 (7.9)
≥ 513 (5.4)
†ENE grade
Grade 0153 (63.2)
Grade 1,252 (21.5)
Grade 337 (15.3)
CNN
No179 (74.0)
Yes63 (26.0)
Treatment
IMRT158 (65.3)
CCRT84 (34.7)
DOI: https://doi.org/10.2478/raon-2022-0047 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
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Language: English
Page range: 479 - 487
Submitted on: Sep 10, 2022
Accepted on: Oct 11, 2022
Published on: Dec 13, 2022
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
nasopharyngeal carcinoma,
stage II,
concurrent chemotherapy,
nomogram,
nodal features
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 2022 Yang Liu, Jianghu Zhang, Jingbo Wang, Runye Wu, Xiaodong Huang, Kai Wang, Yuan Qu, Xuesong Chen, Yexiong Li, Ye Zhang, Junlin Yi, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.

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