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. 2023 Jul 9;14(11):2085-2092.
doi: 10.7150/jca.84854. eCollection 2023.

Prognostic Value of Lymph Node Necrosis at Different N Stages in Patients with Nasopharyngeal Carcinoma

Yue-Chun Fu  1 , Shao-Bo Liang  2 , Wen-Jie Huang  3 , Lu-Si Chen  4 , Dan-Ming Chen  5 , Li-Zhi Liu  3 , Min Luo  6 , Xiao-Fen Zhong  7 , Xiang-Ying Xu  2
Affiliations

Prognostic Value of Lymph Node Necrosis at Different N Stages in Patients with Nasopharyngeal Carcinoma

Yue-Chun Fu et al. J Cancer. .

Abstract

Background: Lymph node necrosis (LNN), including retropharyngeal nodal necrosis and cervical nodal necrosis, which is related to radiotherapy/ chemotherapy resistance, is a common phenomenon in nasopharyngeal carcinoma (NPC). This study was to assess the prognostic value of LNN at different N stages in NPC patients. Materials and Methods: In total, 1,665 newly diagnosed NPC patients at stage TxN1-3M0 from two centers were enrolled. Univariate and multivariate models were constructed to assess the association between LNN and long-term survival outcomes. The propensity score matching method was performed to balance treatment groups for baseline characteristics. Results: Of the 1,665, 540 patients (540/1665, 32.4%) were diagnosed with LNN, of which 54.1% (292/540) patients were at stage N1, 31.3% (169/540) at stage N2, and 14.6% (79/540) at stage N3. Univariate and multivariate analyses indicated LNN as an independent predictor for progression‑free survival (PFS), overall survival (OS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS) in stage N1-3 patients (all P<0.001). When patients were analyzed according to stage, similar findings were observed for N1 patients (all P<0.001); for N2 patients, LNN independently predicted PFS (P=0.003), OS (P=0.011), and DMFS (P=0.004), and for stage N3, LNN only independently predicted LRRFS (P=0.019). 123 pairs of patients who received induction chemotherapy plus concurrent chemoradiotherapy or only concurrent chemoradiotherapy were matched, adding induction chemotherapy improved 5-year OS, PFS and LRFFS, but the results were not statistically significant. Conclusions: In NPC patients, LNN could independently predict poor prognosis at all N1-3 stages and at each N stage (N1 to N3). The value of adding induction chemotherapy to concurrent chemoradiotherapy in patients with LNN still requires further prospective studies.

Keywords: induction chemotherapy; lymph node necrosis; nasopharyngeal carcinoma; prognosis; stage N1-3.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Progression-free survival of NPC patients with and without LNN. (A) 1,665 patients at stage N1-3, (B) 1,162 patients at stage N1, (C) 353 patients at stage N2, (D) 150 patients at stage N3.
Figure 2
Figure 2
Prognostic comparison of 1,665 stage N1-3 NPC patients with and without LNN. (A) Overall survival, (B) Distant metastasis-free survival, (C) Locoregional relapse-free survival.
Figure 3
Figure 3
Prognostic comparison of 1,162 stage N1 NPC patients with and without LNN. (A) Overall survival, (B) Distant metastasis-free survival, (C) Locoregional relapse-free survival.
Figure 4
Figure 4
Prognostic comparison of 353 stage N2 NPC patients with and without LNN. (A) Overall survival, (B) Distant metastasis-free survival.
See this image and copyright information in PMC

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