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. 2024 Apr 16;24(1):483.
doi: 10.1186/s12885-024-12259-w.

Efficacy of salvage surgery versus re-irradiation for isolated regional lymph node recurrence in patients with nasopharyngeal carcinoma

Yuebing Chen #  1 , Yiping Huang #  1 , Xiaoqiang Chen  2 , Zhiwei Chen  3   4 , Xiane Peng  5 , Shaojun Lin  1   6 , Cheng Lin  7 , Jingfeng Zong  8
Affiliations

Efficacy of salvage surgery versus re-irradiation for isolated regional lymph node recurrence in patients with nasopharyngeal carcinoma

Yuebing Chen et al. BMC Cancer. .

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.

Keywords: Lymph node dissection; Nasopharyngeal carcinoma; Re-irradiation; Recurrence; Regional lymph nodes.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow of the study selection process
Fig. 2
Fig. 2
A Kaplan‒Meier curves of overall survival (OS) in this cohort. B-D Comparisons of OS, regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) between the Surgery group and Re-irradiation group of patients with isolated regional lymph node recurrent nasopharyngeal carcinoma (irrNPC). E-I K‒M curves of OS and DMFS in patients with irrNPC stratified by age at recurrence, rENE, rN classification and failure patterns
Fig. 3
Fig. 3
A Nomogram model for overall survival based on age at recurrence and the rENE and rN classifications. B Calibration curves for predicting overall survival at 3 and 5 years
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