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MRI-identified multidimensional nodal features predict survival and concurrent chemotherapy benefit for stage II nasopharyngeal carcinoma

Yang Liu
Yang Liu
, 
Jianghu Zhang
Jianghu Zhang
, 
Jingbo Wang
Jingbo Wang
, 
Runye Wu
Runye Wu
, 
Xiaodong Huang
Xiaodong Huang
, 
Kai Wang
Kai Wang
, 
Yuan Qu
Yuan Qu
, 
Xuesong Chen
Xuesong Chen
, 
Yexiong Li
Yexiong Li
, 
Ye Zhang
Ye Zhang
 and 
Junlin Yi
Junlin Yi
   | Dec 13, 2022
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Article Category: Research Article
Published Online: Dec 13, 2022
Page range: 479 - 487
Received: Sep 10, 2022
Accepted: Oct 11, 2022
DOI: https://doi.org/10.2478/raon-2022-0047
© 2022 Yang Liu, Jianghu Zhang, Jingbo Wang, Runye Wu, Xiaodong Huang, Kai Wang, Yuan Qu, Xuesong Chen, Yexiong Li, Ye Zhang, Junlin Yi, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Axial T1-weighted fat-suppressed contrast MRI images of grade 0–2 extranodal extension (ENE) in four stage II nasopharyngeal carcinoma patients. (A) Grade 0: without ENE; (B) Grade 1: lymph node (LN) infiltrating surrounding fat; (C) Grade 2: matted LNs; and (D) Grade 3: LN infiltrating sternocleidomastoid muscle (wight arrows).
Axial T1-weighted fat-suppressed contrast MRI images of grade 0–2 extranodal extension (ENE) in four stage II nasopharyngeal carcinoma patients. (A) Grade 0: without ENE; (B) Grade 1: lymph node (LN) infiltrating surrounding fat; (C) Grade 2: matted LNs; and (D) Grade 3: LN infiltrating sternocleidomastoid muscle (wight arrows).

Figure 2

Multidimensional nodal features of stage II nasopharyngeal carcinoma significantly associated with survival outcomes in univariate or multivariate analysis. Axial T2-weighted fat-suppressed image of (A) a 24-year-old man with one lymph nodes (LN) in level III; (B) a 56-year-old man with maximum diameter of lymph node 3.3cm; (C) a 50-year-old woman with four metastatic LNs; and (D) Sagittal T1-weighted fat-suppressed contrast images of a 45-year-old woman showing central nodal necrosis (CNN) (wight arrows). MAD = maximal axial diameter
Multidimensional nodal features of stage II nasopharyngeal carcinoma significantly associated with survival outcomes in univariate or multivariate analysis. Axial T2-weighted fat-suppressed image of (A) a 24-year-old man with one lymph nodes (LN) in level III; (B) a 56-year-old man with maximum diameter of lymph node 3.3cm; (C) a 50-year-old woman with four metastatic LNs; and (D) Sagittal T1-weighted fat-suppressed contrast images of a 45-year-old woman showing central nodal necrosis (CNN) (wight arrows). MAD = maximal axial diameter

Figure 3

Nomogram and calibration plots of 5- and 10-year overall survival (OS). Number of positive lymph nodes was as continuous variable.
Nomogram and calibration plots of 5- and 10-year overall survival (OS). Number of positive lymph nodes was as continuous variable.

Figure 4

Comparison of (A) area under the curve (AUC) plots, decision curves of (B) 5-year overall survival (OS) and (C) 10-year OS between the nomogram and TNM stage.
Comparison of (A) area under the curve (AUC) plots, decision curves of (B) 5-year overall survival (OS) and (C) 10-year OS between the nomogram and TNM stage.

Figure 5

Survival curves of the (A–D) three subgroups in American Joint Committee on Cancer staging system (AJCC), TNM staging and (E–H) the low- and high-risk groups stratified by the nomogram-derived score.
Survival curves of the (A–D) three subgroups in American Joint Committee on Cancer staging system (AJCC), TNM staging and (E–H) the low- and high-risk groups stratified by the nomogram-derived score.

Figure 6

Impact of concurrent
Impact of concurrent

Figure 7

The 5-year and 10-year overall survival (OS) rates and hazard ratio (HR) between intensity-modulated radiotherapy (IMRT) group and concurrent chemoradiotherapy (CCRT) group according to (A) TNM staging system and (B) prognostic risk model.
The 5-year and 10-year overall survival (OS) rates and hazard ratio (HR) between intensity-modulated radiotherapy (IMRT) group and concurrent chemoradiotherapy (CCRT) group according to (A) TNM staging system and (B) prognostic risk model.

Characteristics of 242 patients with stage II nasopharyngeal carcinoma

Characteristics No. (%)
Age, median (range) 50 (18–76)
< 50 120 (49.6)
≥ 50 122 (50.4)
Sex
Male 173 (71.5)
Female 69 (28.5)
AJCC 8th T stage
T1 104 (43.0)
T2 138 (57.0)
AJCC 8th N stage
N0 30 (12.4)
N1 212 (87.6)
AJCC 8th subgroup
T1N1M0 104 (43.0)
T2N0M0 31 (12.8)
T2N1M0 107 (44.2)
GTVnx volume (cm3), median (range) 19.1 (2.1–74.0)
< 13.7 70 (28.9)
≥ 13.7 172 (71.1)
GTVnd volume (cm3), median (range) 8.7 (0–71.0)
< 29.1 212 (87.6)
≥ 29.1 30 (12.4)
Lateral of RPLNs
None 90 (37.2)
Unilateral 113 (46.7)
Bilateral 39 (16.1)
LN located in level III
Yes 195 (80.6)
No 47 (19.4)
LN size (cm) 1.7 (0–6.0)
MAD < 2.2 152 (62.8)
MAD ≥ 2.2 90 (37.2)
Number of positive LN 2 (0– 9)
0 30 (12.4)
1 69 (28.5)
2 60 (24.8)
3 51 (21.1)
4 19 (7.9)
≥ 5 13 (5.4)
†ENE grade
Grade 0 153 (63.2)
Grade 1,2 52 (21.5)
Grade 3 37 (15.3)
CNN
No 179 (74.0)
Yes 63 (26.0)
Treatment
IMRT 158 (65.3)
CCRT 84 (34.7)
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