鼻咽癌患者咽后淋巴结临床及影像学特征与局部治疗失败的相关性分析

MRI features of retropharyngeal lymph nodes may predict 3-year local failure in patients with nasopharyngeal carcinoma

目的探讨鼻咽癌患者咽后淋巴结(RLN)临床及影像学特征与淋巴结局部治疗失败的关系。方法收集2010年收治的255例初治鼻咽癌患者的临床资料,分析RLN影像学特征和临床特征,统计RLN 3年局部治疗失败率(LFR),并进一步分析淋巴结影像学及临床特征与RLN 3年LFR之间的相关性。结果 255例鼻咽癌患者中,有RLN患者共209例,总324颗。随访3年,未控9颗,复发3颗,LFR为3.70%。具有坏死表现的咽后淋巴结LFR明显高于无坏死表现的LFR(P=0.0325)。具有液化表现的咽后淋巴结LFR明显高于无液化表现的LFR(P=0.005)。根据大部分液化与否分组,也观察到类似的表现(P=0.0007),大部分液化RLN的患者高度提示3年内局部治疗失败可能。与仅单侧RLN阳性的患者相比,双侧RLN阳性的患者发生局部治疗失败的可能性有升高的趋势,但差异无统计学意义(P=0.227)。按照单个或多个RLN对患者进行分组,也观察到类似结果(P=0.349)。RLN最短轴径、体积、包膜外侵与其预后没有相关性(均P>0.05)。结论 RLN的坏死、液化及大部分液化,与RLN 3年LFR正相关。其中大部分液化表现高度提示3年内局部治疗失败。因此,针对RLN液化坏死严重的患者,临床上需要在治疗初始给予更多关注和治疗上的不同措施。

Objective To investigate the prognostic value of MRI features of retropharyngeal lymph nodes （RLN） for 3- year local failure rate（LFR） in patients with nasopharyngeal carcinoma （NPC）. Methods Clinical data of 225 newly diagnosed patients with NPC admitted in Zhejiang Provincial Cancer Hospital from January 2010 to December 2010 were retrospectively analyzed. Al patients underwent magnetic resonance imaging （MRI） examinations before treatment. The relationship between MRI features of RNL and 3- y LFR was analyzed. Results Two hundred and nine （81.9%） out of 255 patients were RLN positive with total y 324 RLNs. Three- year fol ow- up showed that 9 RLNs were not control ed and 3 recurred with a LFR of 3.70%. Uni-variate analysis revealed that patients with necrosis and liquefaction of RLN had significantly higher LFR compared to those without （P=0.0325 and P=0.005, respectively）. Bilateral RNLs had a higher LFR than unilateral RNLs （P=0.227）. There were no significant differences in LFR between patients with multiple RNLs and single RNLs（P=0.349）. LFR was not correlated with mini-mal axial diameter of tumor, tumor volumes and status of RLN＇s capsules （al P〉0.05）. Conclusion The necrosis and liquefac-tion of RNL on MRI may predict LFR and disease progression in patients with NPC.