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Larger lymph node threshold found to optimize nasopharyngeal carcinoma outcomes

Larger lymph node threshold optimizes nasopharyngeal carcinoma outcomes
Credit: AJR

According to the American Journal of Roentgenology (AJR), using a 6-mm threshold, rather than a 5-mm threshold, helps facilitate better risk stratification and treatment decisions in patients with nasopharyngeal carcinoma (NPC).

"Future American Joint Committee on Cancer (AJCC) staging updates should consider incorporation of the 6-mm threshold for N-category and tumor-stage determinations," wrote corresponding author Zhiying Liang, MD, from the radiology department at China's Sun Yat-sen University Cancer Center.

This AJR accepted manuscript by Liang et al. included 1,752 patients (, 46 years; 1,297 men, 455 women) with NPC treated by intensity-modulated radiotherapy from January 2010 to March 2014 from two hospitals; 438 patients underwent MRI 3-4 months after treatment.

Two measured the minimal axial diameter (MAD) of the largest retropharyngeal lymph node (RLN) for each patient via consensus. Then, to assess interobserver agreement, a third radiologist measured MAD in 260 randomly selected patients. Initial ROC and restricted cubic spline analyses were used to derive an optimal MAD threshold for predicting (PFS).

Ultimately, in patients with NPC, overall survival was significantly different between with stage-I and stage-II disease defined using a 6-mm threshold (p = .04)—but not using a 5-mm threshold (p = .09). The 5-year PFS rate was associated with post-radiotherapy MAD ≥ 6 mm (HR = 1.68, p = .04) but not with post-radiotherapy MAD ≥ 5 mm (HR = 1.09, p = .71).

"Given the absence of a defined size threshold in the AJCC 8th edition staging manual," the authors noted, "we propose that future updates to the manual incorporate this threshold for N-category and tumor-stage determinations."

More information: Yuliang Zhu et al, Optimal Size Threshold for MRI-Detected Retropharyngeal Lymph Nodes to Predict Outcomes in Nasopharyngeal Carcinoma: A Two-Center Study, American Journal of Roentgenology (2023). DOI: 10.2214/AJR.23.29984

Citation: Larger lymph node threshold found to optimize nasopharyngeal carcinoma outcomes (2023, September 29) retrieved 28 November 2023 from
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