High‐grade radiologic extra‐nodal extension predicts distant metastasis in stage II nasopharyngeal carcinoma

• Published in: Head & neck Vol. 41; no. 9; pp. 3317 - 3327
• Main Authors: Hu, Yujun, Lu, Tianzhu, Huang, Shao Hui, Lin, Shaojun, Chen, Yunbin, Fang, Yanhong, Zhou, Han, Chen, Yiping, Zong, Jingfeng, Zhang, Yu, Chen, Ying, Pan, Jianji, Xiao, Youping, Guo, Qiaojuan
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.09.2019; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Aged, 80 and over; Female; Head and neck; Humans; intensity‐modulated radiation therapy; Magnetic Resonance Imaging; Male; Metastases; Metastasis; Middle Aged; Nasopharyngeal carcinoma; Nasopharyngeal Carcinoma - diagnostic imaging; Nasopharyngeal Carcinoma - mortality; Nasopharyngeal Carcinoma - secondary; Nasopharyngeal Neoplasms - diagnostic imaging; Nasopharyngeal Neoplasms - mortality; Nasopharyngeal Neoplasms - pathology; Neoplasm Grading; Neoplasm Staging; Observer Variation; Predictive Value of Tests; radiologic extra‐nodal extension; Reproducibility of Results; Retrospective Studies; risk of distant metastasis; stage II; Survival; Survival Rate; Throat cancer; Young Adult; nasopharyngeal carcinoma; radiologic extra-nodal extension; stage II; risk of distant metastasis; intensity-modulated radiation therapy
• ISSN: 1043-3074; 1097-0347; 1097-0347
• DOI: 10.1002/hed.25842

Background To investigate the prognostic value of radiologic extra‐nodal extension (rENE) in stage II nasopharyngeal carcinoma (NPC). Methods Stage II NPC patients with N1 category (n = 365) were enrolled and divided into three groups according to the situation of rENE: without rENE, suspected rENE, and confirmed rENE (grades: A, infiltration into surrounding fat; B, matted nodes; C, infiltration into adjacent structures). Results Only high‐grade rENE (including matted nodes and infiltration into adjacent structures) could significantly influence the survival outcomes, patients with high‐grade rENE had significantly poorer survival than those without, with the 7‐year distant metastasis‐free survival and overall survival demonstrated to be 78.5% vs 93.0% (P < .001) and 81.9% vs 89.9% (P = .05), respectively. High‐grade rENE, as defined in our study, is a stable criterion, with high intra‐rater and inter‐rater consistency. Conclusion High‐grade rENE was an evaluable predictor that could help with the selection of stage II patients with high risk of distant metastasis.