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Article: Unambiguous advanced radiologic extranodal extension determined by MRI predicts worse outcomes in nasopharyngeal carcinoma: Potential improvement for future editions of N category systems

TitleUnambiguous advanced radiologic extranodal extension determined by MRI predicts worse outcomes in nasopharyngeal carcinoma: Potential improvement for future editions of N category systems
Authors
KeywordsRadiologic extranodal extension
Prognostication
Nasopharyngeal carcinoma
Magnetic resonance imaging
Recursive partitioning analysis
Issue Date2021
PublisherElsevier Ireland Ltd. The Journal's web site is located at http://www.elsevier.com/locate/radonc
Citation
Radiotherapy & Oncology, 2021, v. 157, p. 114-121 How to Cite?
AbstractBackground and purpose: To explore the prognostic value of different radiologic extranodal extension (rENE) grades and their potential improvement for the 8th edition N category in nasopharyngeal carcinoma (NPC). Materials and methods: From 2009 to 2013, a cohort of 1887 patients with NPC was retrospectively enrolled and randomized to the training (n = 955) and validation (n = 932) groups. rENE was categorized as follows: grade 0, nodes without rENE; grade 1, nodes with rENE infiltrating the surrounding fat only; grade 2, matted nodes; grade 3, nodes with rENE infiltrating adjacent structures. Results: The percentage of patients with MRI-positive cervical nodes was 66.5% (1254/1887), of whom grade 0, 1, 2 and 3 rENE cases accounted for 33.2% (416/1254), 14.9% (187/1254), 36.5% (458/1254) and 15.4% (193/1254), respectively. The kappa coefficients for the inter-rater and intra-rater assessments were 0.63, 0.51, 0.65 and 0.93, and 0.76, 0.69, 0.72 and 1.0 in grade 0, 1, 2 and 3 rENE, respectively. Grade 3 rENE rather than grades 0–2 rENE was an independent unfavorable predictor of overall survival and disease-free survival (P < 0.001). Recursive partitioning analysis was applied to refine the N category: eN0 (N0), eN1 (N1 without grade 3), eN2 (N2 without grade 3), and eN3 (N1/N2 with grade 3, N3). Compared to the current system, the proposed N category performed better in hazard consistency, hazard discrimination, sample size balance and outcome prediction. Conclusion: Grade 3 rENE was an independent unfavorable indicator of NPC. Upstaging patients in N1-2 with grade 3 rENE to N3 led to a superior prognostic performance.
Persistent Identifierhttp://hdl.handle.net/10722/300731
ISSN
2020 Impact Factor: 6.28
2015 SCImago Journal Rankings: 2.654

 

DC FieldValueLanguage
dc.contributor.authorMao, Y-
dc.contributor.authorWang, S-
dc.contributor.authorLydiatt, W-
dc.contributor.authorShah, JP-
dc.contributor.authorColevas, AD-
dc.contributor.authorLee, AWM-
dc.contributor.authorO'Sullivan, B-
dc.contributor.authorGuo, R-
dc.contributor.authorLuo, W-
dc.contributor.authorChen, Y-
dc.contributor.authorTian, L-
dc.contributor.authorTang, L-
dc.contributor.authorSun, Y-
dc.contributor.authorLiu, L-
dc.contributor.authorRen, J-
dc.contributor.authorMa, J-
dc.date.accessioned2021-06-18T14:56:15Z-
dc.date.available2021-06-18T14:56:15Z-
dc.date.issued2021-
dc.identifier.citationRadiotherapy & Oncology, 2021, v. 157, p. 114-121-
dc.identifier.issn0167-8140-
dc.identifier.urihttp://hdl.handle.net/10722/300731-
dc.description.abstractBackground and purpose: To explore the prognostic value of different radiologic extranodal extension (rENE) grades and their potential improvement for the 8th edition N category in nasopharyngeal carcinoma (NPC). Materials and methods: From 2009 to 2013, a cohort of 1887 patients with NPC was retrospectively enrolled and randomized to the training (n = 955) and validation (n = 932) groups. rENE was categorized as follows: grade 0, nodes without rENE; grade 1, nodes with rENE infiltrating the surrounding fat only; grade 2, matted nodes; grade 3, nodes with rENE infiltrating adjacent structures. Results: The percentage of patients with MRI-positive cervical nodes was 66.5% (1254/1887), of whom grade 0, 1, 2 and 3 rENE cases accounted for 33.2% (416/1254), 14.9% (187/1254), 36.5% (458/1254) and 15.4% (193/1254), respectively. The kappa coefficients for the inter-rater and intra-rater assessments were 0.63, 0.51, 0.65 and 0.93, and 0.76, 0.69, 0.72 and 1.0 in grade 0, 1, 2 and 3 rENE, respectively. Grade 3 rENE rather than grades 0–2 rENE was an independent unfavorable predictor of overall survival and disease-free survival (P < 0.001). Recursive partitioning analysis was applied to refine the N category: eN0 (N0), eN1 (N1 without grade 3), eN2 (N2 without grade 3), and eN3 (N1/N2 with grade 3, N3). Compared to the current system, the proposed N category performed better in hazard consistency, hazard discrimination, sample size balance and outcome prediction. Conclusion: Grade 3 rENE was an independent unfavorable indicator of NPC. Upstaging patients in N1-2 with grade 3 rENE to N3 led to a superior prognostic performance.-
dc.languageeng-
dc.publisherElsevier Ireland Ltd. The Journal's web site is located at http://www.elsevier.com/locate/radonc-
dc.relation.ispartofRadiotherapy & Oncology-
dc.subjectRadiologic extranodal extension-
dc.subjectPrognostication-
dc.subjectNasopharyngeal carcinoma-
dc.subjectMagnetic resonance imaging-
dc.subjectRecursive partitioning analysis-
dc.titleUnambiguous advanced radiologic extranodal extension determined by MRI predicts worse outcomes in nasopharyngeal carcinoma: Potential improvement for future editions of N category systems-
dc.typeArticle-
dc.identifier.emailLee, AWM: awmlee@hkucc.hku.hk-
dc.identifier.authorityLee, AWM=rp02056-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.radonc.2021.01.015-
dc.identifier.pmid33516790-
dc.identifier.scopuseid_2-s2.0-85100631028-
dc.identifier.hkuros322791-
dc.identifier.volume157-
dc.identifier.spage114-
dc.identifier.epage121-
dc.publisher.placeIreland-

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