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Larger lymph node threshold optimizes nasopharyngeal carcinoma outcomes

A 6-mm threshold helps facilitate better risk stratification and treatment decisions in patients with nasopharyngeal carcinoma.

Larger lymph node threshold optimizes nasopharyngeal carcinoma outcomes
2023-09-29
(Press-News.org) Leesburg, VA, September 29, 2023—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 (median age, 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 radiologists 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 progression-free survival (PFS).

Ultimately, in patients with NPC, overall survival was significantly different between patients 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 AJR authors noted, “we propose that future updates to the manual incorporate this threshold for N-category and tumor-stage determinations.”

A supplement to this AJR article is available here.

North America’s first radiological society, the American Roentgen Ray Society (ARRS) remains dedicated to the advancement of medicine through the profession of medical imaging and its allied sciences. An international forum for progress in radiology since the discovery of the x-ray, ARRS maintains its mission of improving health through a community committed to advancing knowledge and skills with the world’s longest continuously published radiology journal—American Journal of Roentgenology—the ARRS Annual Meeting, InPractice magazine, topical symposia, myriad multimedia educational materials, as well as awarding scholarships via The Roentgen Fund®.

MEDIA CONTACT:

Logan K. Young, PIO

44211 Slatestone Court

Leesburg, VA 20176

lyoung@arrs.org

END


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[Press-News.org] Larger lymph node threshold optimizes nasopharyngeal carcinoma outcomes
A 6-mm threshold helps facilitate better risk stratification and treatment decisions in patients with nasopharyngeal carcinoma.