PDF(Pubmed)
Abstract：
BACKGROUND: To compare the clinical characteristics and prognoses of patients with isolated regional lymph node recurrent nasopharyngeal carcinoma (irrNPC) who underwent surgery or re-irradiation treatment.
METHODS: We retrospectively reviewed 124 irrNPC patients who underwent initial radiotherapy between January 2010 and December 2020. The staging of regional lymph node recurrence was as follows: 75.8% for rN1, 14.5% for rN2, and 9.7% for rN3. Fifty-five patients underwent regional lymph node surgery (Surgery group), and sixty-nine patients received salvage radiotherapy with or without chemotherapy (Re-irradiation group). The survival rate was compared using Kaplan‒Meier analysis and evaluated by the log-rank test. Cox proportional hazard models were used to analyze prognostic factors.
RESULTS: The median follow-up time was 70 months, the 5-year overall survival (OS) was 74%, and the median survival time was 60.8 months. There were no significant differences in 5-year OS (75.6% vs. 72.4%, P = 0.973), regional recurrence-free survival (RRFS, 62.7% vs. 71.1%, P = 0.330) or distant metastasis-free survival (DMFS, 4.2% vs.78.7%, P = 0.677) between the Surgery group and Re-irradiation group. Multivariate analysis revealed age at recurrence, radiologic extra-nodal extension (rENE) status, and recurrent lymph node (rN) classification as independent prognostic factors for OS. The rENE status was an independent prognostic factor for DMFS. Subgroup analysis of the Surgery group revealed that the rN3 classification was an adverse prognostic factor for OS. Age at recurrence ≥ 50 years, GTV-N dose, and induction chemotherapy were found to be independent prognostic factors for OS, RRFS, and DMFS, respectively, in the Re-irradiation group.
CONCLUSIONS: For NPC patients with isolated regional lymph node recurrence after initial radiotherapy, those who underwent surgery had survival prognosis similar to those who underwent re-radiotherapy with or without chemotherapy. A prospective study is needed to validate these findings.
METHODS: We retrospectively reviewed 124 irrNPC patients who underwent initial radiotherapy between January 2010 and December 2020. The staging of regional lymph node recurrence was as follows: 75.8% for rN1, 14.5% for rN2, and 9.7% for rN3. Fifty-five patients underwent regional lymph node surgery (Surgery group), and sixty-nine patients received salvage radiotherapy with or without chemotherapy (Re-irradiation group). The survival rate was compared using Kaplan‒Meier analysis and evaluated by the log-rank test. Cox proportional hazard models were used to analyze prognostic factors.
RESULTS: The median follow-up time was 70 months, the 5-year overall survival (OS) was 74%, and the median survival time was 60.8 months. There were no significant differences in 5-year OS (75.6% vs. 72.4%, P = 0.973), regional recurrence-free survival (RRFS, 62.7% vs. 71.1%, P = 0.330) or distant metastasis-free survival (DMFS, 4.2% vs.78.7%, P = 0.677) between the Surgery group and Re-irradiation group. Multivariate analysis revealed age at recurrence, radiologic extra-nodal extension (rENE) status, and recurrent lymph node (rN) classification as independent prognostic factors for OS. The rENE status was an independent prognostic factor for DMFS. Subgroup analysis of the Surgery group revealed that the rN3 classification was an adverse prognostic factor for OS. Age at recurrence ≥ 50 years, GTV-N dose, and induction chemotherapy were found to be independent prognostic factors for OS, RRFS, and DMFS, respectively, in the Re-irradiation group.
CONCLUSIONS: For NPC patients with isolated regional lymph node recurrence after initial radiotherapy, those who underwent surgery had survival prognosis similar to those who underwent re-radiotherapy with or without chemotherapy. A prospective study is needed to validate these findings.
摘要：
背景：比较接受手术或再次放疗的孤立区域淋巴结复发鼻咽癌（irrNPC）患者的临床特征和预后。
方法：我们回顾性分析了在2010年1月至2020年12月期间接受初始放疗的124例刺激性NPC患者。区域淋巴结复发的分期如下：rN1为75.8％，rN2为14.5％，rN3为9.7％。55例患者接受了区域淋巴结手术（手术组），69例患者接受了有或没有化疗的挽救性放疗（再放疗组）。使用Kaplan-Meier分析比较生存率，并通过对数秩检验进行评估。Cox比例风险模型用于分析预后因素。
结果：中位随访时间为70个月，5年总生存率（OS）为74％，中位生存时间为60.8个月。5年OS没有显著差异(75.6%与72.4%,P=0.973),区域无复发生存率(RFS，62.7%vs.71.1%,P=0.330）或无远处转移生存率（DMFS，4.2%vs.78.7%，手术组和再照射组之间的P=0.677）。多因素分析显示复发时的年龄，放射学结外延伸(rENE)状态，复发淋巴结（rN）分类是OS的独立预后因素。rENE状态是DMFS的独立预后因素。手术组的亚组分析显示，rN3分类是OS的不良预后因素。复发年龄≥50岁，GTV-N剂量,诱导化疗是OS的独立预后因素，RFS,和DMFS,分别,在再照射组中。
结论：对于初次放疗后孤立区域淋巴结复发的鼻咽癌患者，接受手术者的生存预后与接受有或没有化疗的再放疗者相似.需要一项前瞻性研究来验证这些发现。
方法：我们回顾性分析了在2010年1月至2020年12月期间接受初始放疗的124例刺激性NPC患者。区域淋巴结复发的分期如下：rN1为75.8％，rN2为14.5％，rN3为9.7％。55例患者接受了区域淋巴结手术（手术组），69例患者接受了有或没有化疗的挽救性放疗（再放疗组）。使用Kaplan-Meier分析比较生存率，并通过对数秩检验进行评估。Cox比例风险模型用于分析预后因素。
结果：中位随访时间为70个月，5年总生存率（OS）为74％，中位生存时间为60.8个月。5年OS没有显著差异(75.6%与72.4%,P=0.973),区域无复发生存率(RFS，62.7%vs.71.1%,P=0.330）或无远处转移生存率（DMFS，4.2%vs.78.7%，手术组和再照射组之间的P=0.677）。多因素分析显示复发时的年龄，放射学结外延伸(rENE)状态，复发淋巴结（rN）分类是OS的独立预后因素。rENE状态是DMFS的独立预后因素。手术组的亚组分析显示，rN3分类是OS的不良预后因素。复发年龄≥50岁，GTV-N剂量,诱导化疗是OS的独立预后因素，RFS,和DMFS,分别,在再照射组中。
结论：对于初次放疗后孤立区域淋巴结复发的鼻咽癌患者，接受手术者的生存预后与接受有或没有化疗的再放疗者相似.需要一项前瞻性研究来验证这些发现。
