Significance of cervical node necrosis in preoperative MRI as a prognostic indicator: retrospective study of patients with SCC of tongue

Aim: To ascertain the prognostic value of cervical nodal necrosis (CNN) observed in patients of tongue squamous cell carcinoma with magnetic resonance imaging. Materials and methods: In this retrospective observational study, records of 144 patients diagnosed with newly diagnosed SCC of tongue were considered. Preoperative MRI study, demographic and clinical data were reviewed. Based on MRI reports, patients were categorised into: with or without the presence of cervical node necrosis (CNN or non CNN). Subsequent treatments, histopathological reports and follow up data were studied to determine key prognostic elements, overall survival and disease free survival by statistical analysis. Results: The incidence of CNN was 55.55% in the study sample. CNN category, depth of invasion, N stage and extra nodal extension were significant negative prognostic factors for overall and disease free survival. Conclusion: Based on our results, pre operative MRI based presence of cervical node necrosis in tongue squamous cell carcinoma is an independent prognostic indicator for poor overall and disease free survival. Long term prospective studies with larger cohorts could be undertaken to establish its role as an important biomarker for precision treatments.

The Value of Cervical Node Features in Predicting Long-Term Survival of Nasopharyngeal Carcinoma in Intensity-Modulated Radiotherapy Era

The prognostic value of cervical node features in nasopharyngeal carcinoma(NPC) patients treated with intensity-modulated radiotherapy (IMRT) was controversial. In this study, about 1752 patients after IMRT from 2008 to 2011 were recruited. The nodal features including the nodal number, maximize dimension diameter, extranodal extension(ENE)and cervical node necrosis(CNN) were retrospective analyzed. Univariate Cox and multivariate proportional hazard regression models were used to test the prognostic value of nodal features. Prognostic nomograms were built to predict the survival. The 10-year distant metastases free survival (DMFS) and disease-specific survival(DSS) rates were 86.5% and 80.8%. By multivariate analysis, the independent factors for the DSS were gender, age, lactate dehydrogenase (LDH), CNN, ENE, T stage and N stage. Nomogram A (without nodal features ) and nomogram B (with nodal features) were built. The calibration curve for the probability of DSS showed good agreement between prediction by nomogram and actual observation.The C-index of nomogram B was higher than for nomogram A in predicting DSS ( 0.708 vs 0.676,P <.01). These results demonstrated the nodal features including the ENE and CNN were negative prognostic factors in patients with NPC, and the prognostic nomogram incorporating the nodal features was more accurate.

N2-3 Stage Nasopharyngeal Carcinoma Patients With Cervical Node Necrosis And Extracapsular Spread Benefit From Capecitabine Maintenance Chemotherapy

Purpose: The purpose of this study was to analyze the efficacy and toxicities of concurrent chemoradiotherapy plus capecitabine maintenance chemotherapy for N2-3 stage nasopharyngeal carcinoma (NPC) with cervical node necrosis (CNN) and extracapsular spread(ECS).Patients and methods: This study included 283 N2-3 stage NPC patients with CNN and extracapsular spread who were treated with concurrent chemoradiotherapy. The prescribed doses delivered to the planning target volumes (PTVs), PTVnx, PTVnd, PTV1, and PTV2, were 68–72, 66–70, 60–64, and 52–56 Gy, respectively, in 30–32 fractions. All patients received induction chemotherapy followed by concurrent chemoradiotherapy with cisplatin alone (80–100 mg/m2, day 1, every 21 days is a cycle).Two weeks after completion of concurrent chemoradiotherapy, oral capecitabine (twice daily after meals for 14 consecutive days every 3 weeks) was administered to maintenance chemotherapy patients. Maintenance chemotherapy was administered for 6 months.Results: The 5-year overall survival (OS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) rates were 84.8%, 95.4%, and 86.6%, respectively, for all patients. The 5-year OS rates for patients who accepted capecitabine maintenance chemotherapy (group 1) and patients without maintenance chemotherapy (group 2) were 93.8% and 82.1% (P=0.021), respectively. The 5-year LRFS rates for groups 1 and 2 were 96.9% and 95.0% (P=0.467), respectively. The 5-year DMFS rates for groups 1 and 2 were 93.8% and 84.4% (P=0.044), respectively. Hand-Foot syndrome, myelotoxic effects, fatigue, and gastrointestinal symptoms were the common but not severe (grades 1–2) toxicities of the capecitabine maintenance chemotherapy.Conclusion: Capecitabine maintenance chemotherapy improves the outcome and reduces the occurrence of distant failure in N2-3 stage NPC patients with CNN and extracapsular spread. The side effects of treatment were generally tolerated. More clinical trials are required to evaluate the efficacy and toxicity of it.