Cell reports. Medicine · 2025
Advanced image-identified extranodal extension of retropharyngeal lymph nodes in the refinement of N classification for nasopharyngeal carcinoma.
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Jiang Wei, Wang Gao-Yuan, Qin Guan-Jie, Zhang Wu-Qi, Zhu Xiao-Dong, Han Ya-Qian, Lei Feng, Shen Liang-Fang, Yang Kun-Yu, Cui Chun-Yan, Tang Ling-Long, Mao Yan-Ping, Chen Lei, Guo Rui, Li Ling, Wu Zheng, Xu Gui-Qiong, Zhou Qin, Huang Jing, Huang Shao-Hui, Li Ji-Bin, Liu Li-Zhi, Ma Jun, Du Xiao-Jing
Аннотация
Advanced extranodal extension (ENE) in cervical lymph nodes (CLNs) increases the risk of distant metastasis in nasopharyngeal carcinoma (NPC). The 9th NPC staging system classifies N1/N2 patients with advanced CLN ENE as N3 due to similar outcomes. However, the prognostic impact of advanced ENE in retropharyngeal lymph nodes (RLNs) remains unclear. In this study of 4,485 patients with non-metastatic NPC, N1/N2 patients with advanced RLN ENE demonstrate better 5-year overall survival (hazard ratio [HR]: 0.60, 95% confidence interval [CI]: 0.38-0.93; HR: 0.57, 95% CI: 0.32-1.00) and failure-free survival (HR: 0.63, 95% CI: 0.44-0.92; HR: 0.52, 95% CI: 0.31-0.86) than N3 patients. Advanced RLN ENE shows a positive correlation with other RLN-related anatomical factors and is not identified as an independent prognostic factor. External validation in 3,849 patients from five centers supports these findings. Based on this evidence, upgrading advanced RLN ENE to N3 is not advised.