摘要
目的基于MRI技术分析下咽鳞状细胞癌咽后区域淋巴结转移率和高危影响因素,以指导临床靶区勾画。方法搜集中国医学科学院肿瘤医院2012-2018年间的下咽癌患者的临床资料,入组的患者需经病理确诊,并且在所有治疗前接受了头颈部MRI检查,并且其淋巴结转移诊断、临床靶区勾画都经过全科查房讨论审核确定。通过建立受试者工作特征曲线找到原发灶体积GTVp及淋巴结体积GTVnd的最佳界值,将患者区分为高GTVp组、低GTVp和高GTVnd组、低GTVnd组后,纳入患者出现咽后区域LNM的高危因素分析,分别用χ2检验和Logistic回归模型行单因素和多因素分析。结果最终纳入患者326例,所有患者颈部淋巴结转移率为90.5%,最常见的区域为Ⅱa区,其次为Ⅲ、Ⅱb、Ⅳ、Ⅶa(咽后)、Ⅴ区。咽后淋巴结转移率为21.5%,原发灶位于咽后壁患者中咽后淋巴结转移率为53.1%。单因素和多因素分析表明肿瘤原发于咽后壁、双侧颈部淋巴结转移、GTVp>47 cm3、GTVnd>22 cm3与咽后淋巴结转移显著相关(P值为0.002、0.020、0.003、0.023)。结论下咽癌咽后淋巴结转移发生率较高,尤其是原发灶位于咽后壁患者。同时具有双侧颈部淋巴结转移、较大肿瘤负荷患者容易出现咽后淋巴结转移。对于具有以上高危因素患者推荐临床靶区勾画时将咽后淋巴结引流区包括在内。
Objective To analyze the incidence and high-risk factors of lymph node metastasis in the retropharyngeal region of hypopharyngeal squamous cell carcinoma based on magnetic resonance imaging(MRI),aiming to guide the delineation of clinical target area.Methods Clinical data of patients who were pathologically diagnosed with hypopharyngeal carcinoma from January 2012 to September 2018 in our center were retrospectively analyzed.All patients received head and neck MRI before treatment.The diagnosis of lymph node metastasis and the delineation of primary gross target volume(GTVp)and lymph nodes target volume(GTVnd)were determined by all the radiation oncologists in head and neck group through twice weekly general round discussion.The cut-off points of GTVp and GTVnd were defined by establishing the receiver operating characteristic curve.All patients were divided into the high GTVp,low GTVp and high GTVnd and low GTVnd groups.Chi-square test was used for univariate analysis and logistic regression was utilized for multivariate analysis to analyze the high-risk factors of patients with retropharyngeal lymph node metastasis.Results A total of 326 patients were included in this study,295 of whom were diagnosed with cervical lymph node metastasis,accounting for 90.5%.The most common involved area was LevelⅡa,followed by LevelⅢ,LevelⅡb,Level IV,LevelⅦa(retropharyngeal),Level Va,and Level Vb.The incidence of retropharyngeal lymph node metastasis was 21.5%,and the incidence was 53.1%in patients with primary tumor located in the posterior pharyngeal wall.Univariate and multivariate analyses showed that patients with tumor originated from the posterior pharyngeal wall(P=0.002),bilateral cervical lymph node metastasis(P=0.020),larger GTVp(greater than 47 cm3,P=0.003),and larger GTVnd(greater than 22 cm3,P=0.023)were significantly associated with the occurrence of retropharyngeal lymph node metastasis.Conclusions The incidence of retropharyngeal lymph node metastasis is high in hypopharyngeal carcinoma,especially in pati
作者
王惠丽
曲媛
王凯
吴润叶
刘清峰
张烨
张世平
肖建平
易俊林
高黎
徐国镇
罗京伟
黄晓东
Wang Huili;Qu Yuan;Wang Kai;Wu Runye;Liu Qingfeng;Zhang Ye;Zhang Shiping;Xiao Jianping;Yi Junlin;Gao Li;Xu Guozhen;Luo Jingwei;Huang Xiaodong(Department of Radiation Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2020年第8期625-628,共4页
Chinese Journal of Radiation Oncology
关键词
下咽肿瘤
淋巴结转移
咽后
高危因素
Hypopharyngeal neoplasm
Lymph node metastasis
Retropharyngeal
High-risk factor
