Identifying adverse nodal features associated with poor prognosis in stage IB nasopharyngeal carcinoma patients based on the 9th AJCC/UICC staging system: Implications for treatment intensification.

Abstract

This study aimed to identify adverse lymph node (LN) features, specifically LN necrosis (LNN) and matted nodes (MNs), for the prediction of poor outcomes in stage IB nasopharyngeal carcinoma (NPC) patients according to the 9th edition of the AJCC/UICC staging system (TNM-9), with the ultimate goal of refining patient stratification and tailoring more individualized treatments. NPC patients classified as stage IB according to the TNM-9 staging system between January 2017 and December 2019 at our institution were candidates for this study. Baseline MRI assessments focusing on LNN and MNs were performed. Overall survival (OS), locoregional control (LRC), distant control (DC) and progression-free survival (PFS) were analyzed. Cox proportional hazards model analysis was used to identify prognostic factors. Among the 318 patients included, 91 (28.6 %) presented with LNN, and 72 (22.6 %) presented with MNs. The presence of LNN and MNs was significantly correlated with inferior OS, DC and PFS. On the basis of these two nodal factors, patients were further categorized into low-risk (Group A, without LNN or MNs), intermediate-risk (Group B, with LNN or MNs), and high-risk (Group C, with both LNN and MNs) groups. As the number of adverse nodal features increased, the 5-year OS (Group A/B/C: 98.9 %/97.7 %/78.1 %, overall P < 0.001), DC (Group A/B/C: 99.5 %/94.2 %/78.3 %, overall P < 0.001), and PFS (Group A/B/C: 95.2 %/87.3 %/70.3 %, overall P < 0.001) decreased, whereas LRC (Group A/B/C: 96.8 %/92.9 %/91.4 %, overall P = 0.189) did not significantly differ. LNN and MNs are adverse LN features that significantly impact the prognosis of stage IB NPC patients. Stratifying patients into low-, intermediate-, and high-risk groups based on these factors provides a more nuanced understanding of prognosis and treatment needs for personalized care.