Prognostic Value of Nodal Matting on MRI in Nasopharyngeal Carcinoma Patients

Abstract

Background: Nodal (N) stage is one of the most important predictors for distant metastasis in nasopharyngeal carcinoma (NPC) patients. It may ignore potentially useful nodal features, such as nodal matting (three or more lymph nodes abutting together with the absence of intervening fat planes). Purpose: To explore the prognostic value of nodal matting in NPC patients and construct a nomogram with nodal matting for predicting distant metastasis-free survival (DMFS). Study type: Retrospective. Population: In all, 792 NPC patients treated with intensity modulated radiation therapy from 2010 to 2013 were enrolled with 2:1 training (n = 527) and validation (n = 65) cohorts. Field Strength/Sequence: T 1-and T 2-weighted imaging at 1.5 or 3.0T. Assessment: Nodal matting and other nodal characteristics were assessed with MRI. MR images were evaluated separately by three radiologists. The association between nodal matting and DMFS was analyzed. Statistical Tests: Univariate and multivariate analyses were performed using the Cox proportional hazards regression model. Nomograms were constructed from a multivariate logistic regression model with and without nodal matting. The predictive accuracy and discriminative ability of the nomograms were determined by concordance index (C-index) and calibration curves. The results were validated using bootstrap resampling and validation cohort. Results: The incidence of nodal matting was 24.6% (195/792) in all patients. In the training cohort, nodal matting was independently associated with DMFS (hazard ratio [HR] = 1.97 [1.05-3.69], P < 0.05). N1 patients with nodal matting had worse DMFS than N1 patients without (P < 0.05). However, no significant difference was observed when comparing N1 patients with nodal matting to N2 patients (P = 0.464). The C-index of the nomogram with nodal matting was higher than the nomogram without (0.717 vs. 0.699, P = 0.084). Data Conclusion: Nodal matting was an independent prognostic factor for DMFS in NPC patients. It may help to select patients at high risk of distant metastasis.

Prognostic value of cervical nodal necrosis on staging imaging of nasopharyngeal carcinoma in era of intensity-modulated radiotherapy: a systematic review and meta-analysis

“…More and more studies have found that the presence of nodal metastases is one of the key factors that predict patients at risk of distant metastases. These studies have gone further to investigate the prognostic values of nodal characteristics in detail [ 42 – 46 ]. Necrosis is easily observed in metastatic nodes from NPC but very rarely in primary tumour (about 2%) on the pre-treatment staging MRI [ 34 ].…”

Prognostic value of cervical nodal necrosis on staging imaging of nasopharyngeal carcinoma in era of intensity-modulated radiotherapy: A systematic review and meta-analysis

“…More and more studies have found that the presence of nodal metastases is one of the key factors that predict patients at risk of distant metastases. These studies have gone further to investigate the prognostic values of nodal characteristics in detail [42][43][44][45][46]. Necrosis is easily observed in metastatic nodes from NPC but very rarely in primary tumour (about 2%) on the pre-treatment staging MRI [34].…”

Optimize the number of cycles of induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma: a propensity score matching analysis

“…Nasopharyngeal carcinoma (NPC) is a common malignant tumor with unbalanced geographic distribution, and It is often diagnosed in Southern China, Southeast Asia and North Africa 1 . Unlike other head and neck cancers, radiation therapy (RT) is the mainstay of treatment for non-metastatic NPC given its deep-seated anatomical location and high sensitivity to radiation.…”