The Comparison of Nodal Stage Determined by Magnetic Resonance Imaging and Clinical Palpation for Nasopharyngeal Carcinoma Patients with Bulky Lymph Node Metastasis

併有龐大頸部淋巴結轉移的鼻咽癌病人以核磁共振及臨床觸診作N分期的比較

吳佳興(Jia-Shing Wu) ； 洪振芳(Cheng-Fang Horng) ； 蔡玉真(Stella Y.C. Tsai) ； 鍾邑林(Yih-Lin Chung) ； 簡哲民(James Jer-Min Jian) ； 鄭鴻鈞(Skye Hongiun Cheng)

《放射治療與腫瘤學》 15卷3期 (2008/09) Pp. 189-199

https://doi.org/10.6316/TRO/200815(3)189

摘要

目的：本研究的目的是探討併有龐大頸部淋巴結轉移的鼻咽癌病人以核磁共振決定最大淋巴結大小及N分期是否較臨床觸診與病人預後有更強相關。
材料與方法：合格的鼻咽癌病人有觸診大於或等於6公分的頸部淋巴結並接受核磁共振作為分期依據。我們排除有遠端或鎖骨上淋巴結轉移的病人。自1992至2005年共有47位病人符合條件。每位病人皆在每週舉行之多專科團隊會議中經共識後決定N分期。病人皆依照醫院治療準則接受同步化學放射治療，加或不加上放射後輔助性化學治療。我們比較核磁共振N分期為N1或N2及N3a的病人的存活及復發部位分佈。
結果：核磁共振N分期為N3a的病人有22位，N1或N2有25位。經過中位數64個月的追蹤後，核磁共振N3組之無病存活率(53%)較N1或N2組(65%)低，但無統計學上意義(p=0.65)。核磁共振N3(下標 a)及N1或N2之五年總存活率及無遠端轉移存活率分別為78%比77%(p=0.5)及70%比65%(p=0.9)。兩群病人的局部或遠端復發部位的比例相似。
結論：併有龐大頸部淋巴結轉移的鼻咽癌病人不論核磁共振N分期為何皆有較差的整體存活。我們建議如果頸部淋巴結在核磁共振上相鄰融合在一起，它們的大小不應分開測量。這些病人應皆定為N3a期。

關鍵字

鼻咽癌 ； 龐大頸部淋巴結 ； 分期 ； 核磁共振

並列摘要

Purpose: This study is to find out whether maximal lymph node size determined by magnetic resonance imaging (MRI) correlates with prognosis better than that determined by clinical palpation for patients with nasopharyngeal carcinoma (NPC) and bulky cervical lymph node metastasis.
Material and Methods: All eligible NPC patients should have cervical lymph node size 6 cm or greater by clinical palpation and use MRI as primary imaging modality. Patients with N3b and distant metastases were excluded from this study. From 1992 to 2005, a total of 47 patients were included. Their MRI nodal stage was determined at weekly multidisciplinary team conference with a consensus. Patients received concurrent chemoradiotherapy with or without adjuvant chemotherapy according to hospital guideline. We compared the survival and failure patterns of MRI N1-2 and MRI N3a patients.
Results: Twenty-two patients were assigned MRI N3a and 25 MRI N1 or N2. With a median follow up of 64 months, the 5-year disease-free survival rate for MRI N3a group (53%) was lower than MRI N1-2 group (65%) but not statistically significant (p=0.56). The 5-year overall survival and metastasis-free survival of MRI N3a vs MRI N1-2 patients were 78% vs. 77% (p= 0.5) and 70% vs. 65% (p= 0.9), respectively. The failure pattern was similar.
Conclusion: NPC patients with clinical bulky cervical lymph node metastasis have relatively poor survival regardless of MRI N-stage. We recommend that if cervical lymph nodes are confluent together, their sizes determined by MRI should not be measured separately. These patients are best to be staged as N3a disease.

並列關鍵字

Nasopharyngeal carcinoma ； Bulky cervical lymph node ； Staging ； Magnetic resonance imaging