PDF(Pubmed)
Abstract：
UNASSIGNED: Among patients with nasopharyngeal carcinoma (NPC), there is no established method to distinguish between patients with residual disease that may eventually progress and those who have achieved cured. We thus aimed to assess the prognostic value of magnetic resonance imaging (MRI)-based lymph node regression grade (LRG) in the risk stratification of patients with NPC following radiotherapy (RT).
UNASSIGNED: This study retrospectively enrolled 387 patients newly diagnosed with NPC between January 2010 and January 2013. A four-category MRI-LRG system based on the areal analysis of RT-induced fibrosis and residual tumor was established. Univariate analysis was performed using the Kaplan-Meier method, and comparisons were conducted via the log-rank test. Multivariate analyses were conducted using Cox regression models to calculate the hazard ratios (HRs) with 95% confidence intervals (CIs) and adjusted P values. Survival curves were calculated using the Kaplan-Meier method and compared using the log-rank test.
UNASSIGNED: The sum of MRI-LRG scores (LRG-sum) was an independent prognostic factor for progression-free survival (PFS) (HR 2.50, 95% CI: 1.28-4.90; P<0.001). LRG-sum ≤9 and >9 showed a poorer 5-year PFS rate than did LRG-sum ≤2 (66.1%, 42.9%, and 77.6%, respectively; P<0.001). A survival clustering analysis-based decision tree model showed more complex interactions among LRG-sum and pretreatment and post-RT Epstein-Barr virus (EBV) DNA, yielding four patient clusters with differentiated disease progression risks (5-year PFS rates of 89.5%, 76.4%, 57.6%, and 27.8%, respectively), which showed better risk stratification than did post-RT EBV DNA alone (P<0.001).
UNASSIGNED: The MRI-LRG system adds prognostic information and is a potentially reliable, noninvasive means to stratify treatment modalities for patients with NPC.
UNASSIGNED: This study retrospectively enrolled 387 patients newly diagnosed with NPC between January 2010 and January 2013. A four-category MRI-LRG system based on the areal analysis of RT-induced fibrosis and residual tumor was established. Univariate analysis was performed using the Kaplan-Meier method, and comparisons were conducted via the log-rank test. Multivariate analyses were conducted using Cox regression models to calculate the hazard ratios (HRs) with 95% confidence intervals (CIs) and adjusted P values. Survival curves were calculated using the Kaplan-Meier method and compared using the log-rank test.
UNASSIGNED: The sum of MRI-LRG scores (LRG-sum) was an independent prognostic factor for progression-free survival (PFS) (HR 2.50, 95% CI: 1.28-4.90; P<0.001). LRG-sum ≤9 and >9 showed a poorer 5-year PFS rate than did LRG-sum ≤2 (66.1%, 42.9%, and 77.6%, respectively; P<0.001). A survival clustering analysis-based decision tree model showed more complex interactions among LRG-sum and pretreatment and post-RT Epstein-Barr virus (EBV) DNA, yielding four patient clusters with differentiated disease progression risks (5-year PFS rates of 89.5%, 76.4%, 57.6%, and 27.8%, respectively), which showed better risk stratification than did post-RT EBV DNA alone (P<0.001).
UNASSIGNED: The MRI-LRG system adds prognostic information and is a potentially reliable, noninvasive means to stratify treatment modalities for patients with NPC.
摘要：
■在鼻咽癌（NPC）患者中，没有确定的方法来区分可能最终进展的残留疾病患者和已经治愈的患者。因此，我们旨在评估基于磁共振成像（MRI）的淋巴结回归分级（LRG）在放疗（RT）后NPC患者的风险分层中的预后价值。
■本研究回顾性纳入了2010年1月至2013年1月间新诊断为NPC的387例患者。建立了基于RT诱导的纤维化和残留肿瘤面积分析的四类MRI-LRG系统。使用Kaplan-Meier方法进行单变量分析，并通过对数秩检验进行比较。使用Cox回归模型进行多变量分析，以95％置信区间（CI）和调整后的P值计算风险比（HR）。使用Kaplan-Meier方法计算存活曲线，并使用对数秩检验进行比较。
■MRI-LRG评分总和(LRG-sum)是无进展生存期(PFS)的独立预后因素(HR2.50,95%CI:1.28-4.90;P<0.001)。LRG-sum≤9和>9的5年PFS率低于LRG-sum≤2(66.1%，42.9%,77.6%,分别；P<0.001)。基于生存聚类分析的决策树模型显示了LRG-sum与预处理和RT后EB病毒（EBV）DNA之间更复杂的相互作用，产生四个具有不同疾病进展风险的患者群(5年PFS率为89.5%，76.4%,57.6%,27.8%,分别)，与单纯RT后EBVDNA相比，显示出更好的风险分层（P<0.001）。
■MRI-LRG系统增加了预后信息，具有潜在的可靠性，对NPC患者的治疗方式进行分层的无创手段。
■本研究回顾性纳入了2010年1月至2013年1月间新诊断为NPC的387例患者。建立了基于RT诱导的纤维化和残留肿瘤面积分析的四类MRI-LRG系统。使用Kaplan-Meier方法进行单变量分析，并通过对数秩检验进行比较。使用Cox回归模型进行多变量分析，以95％置信区间（CI）和调整后的P值计算风险比（HR）。使用Kaplan-Meier方法计算存活曲线，并使用对数秩检验进行比较。
■MRI-LRG评分总和(LRG-sum)是无进展生存期(PFS)的独立预后因素(HR2.50,95%CI:1.28-4.90;P<0.001)。LRG-sum≤9和>9的5年PFS率低于LRG-sum≤2(66.1%，42.9%,77.6%,分别；P<0.001)。基于生存聚类分析的决策树模型显示了LRG-sum与预处理和RT后EB病毒（EBV）DNA之间更复杂的相互作用，产生四个具有不同疾病进展风险的患者群(5年PFS率为89.5%，76.4%,57.6%,27.8%,分别)，与单纯RT后EBVDNA相比，显示出更好的风险分层（P<0.001）。
■MRI-LRG系统增加了预后信息，具有潜在的可靠性，对NPC患者的治疗方式进行分层的无创手段。
