鼻咽癌淋巴结转移规律的Meta分析

Meta analysis of lymph node metastasis pattern of nasopharyngeal carcinoma

目的通过已经发表的文献来研究鼻咽癌淋巴结转移的规律和可能性，以建立一个描绘和选择N0、N1期鼻咽癌颈部淋巴结范围的适形放疗标准。方法检索万方、CBM、PubMed、Cochrane Library数据库收集以MRI为主要或者唯一影像学诊断方式的鼻咽癌临床试验，提取数据，采用Stata12.0进行Meta分析。结果从963篇原始文献中，纳入21篇临床试验，最常见的淋巴结转移区域为咽后淋巴结（67%）和Ⅱ区淋巴结（71%）；Ⅲ、Ⅳ、Ⅴ区淋巴结转移率分别为37%、14%、21%；低转移率淋巴结区包括ⅠA、ⅠB、Ⅵ和腮腺淋巴结，转移率分别为0、2%、2%、1%。淋巴结转移规律是自上而下循序性扩展，而跳跃性转移的可能性在0.5%-7.9%之间。结论鼻咽癌淋巴结转移存在一个可以预期的循序性转移规律，并且跳跃性转移是非常罕见的，以此证实了鼻咽癌N0、N1期治疗以适形放疗减少射野的方式是可行的。

ObjectiveBased on the published articles, this paper aims to study the pattern and probability of lymph nodes metastasis in nasopharyngeal carcinoma （NPC） and establish a radiotherapy standard for selecting and delineation of clinical target volume of neck lymphatics for NPC patients with N0 or N1.MethodsClinical trials about NPC by MRI as the main or only diagnostic imaging way were collected and extracted from database, such as WanFang, CBM, PubMed, Cochrane Library. Statistical analyses were performed using Stata software, version 12.0. ResultsTwentyone clinical trials from 963 original articles were included in this analysis. The most commonly involved regions included retropharyngeal （67%） and level Ⅱ lymph nodes （71%）. The overall probability of levels Ⅲ, Ⅳ and Ⅴnodal involvement were 37%, 14% and 21%, respectively. Lowrisk node groups included levels ⅠA, ⅠB, Ⅵ nodes, and the rates of lymph node metastasis were 0, 2%, 2% and 1%, respectively. Nodal metastases followed an orderly pattern of topdown, and the probability of ＂skip＂ metastasis between levels varied between 0.5%-7.9%. ConclusionLymph node metastasis in NPC follows a predictable and orderly pattern. The rarity of metastasis in certain nodal groups and ＂skip＂ metastasis suggest that reduced treatment volume is feasible in conformal radiotherapy for NPC patients with N0 or N1.