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

Figures & data

Figure 1 Representative MRI results illustrating the cervical nodal necrosis (CNN) and extranodal extension (ENE) in two patients with NPC. (A) Axial T1WI and (B) Axial T2WI in a 41-year-old man with CNN (arrows); (C) Axial T1WI and (D) contrast-enhanced T1WI in a 45-year-old man with ENE infiltrating the adjacent muscle (stars).

Table 1 Characteristics of 1752 Patients and Univariate Analysis

Characteristics	No.	10y-LRFS (%)	P value	10y-DMFS (%)	P value	10y-DSS (%)	P value
Gender,
Male	1279	93.8	0.13	85.8	0.01	78.7	<0.01
Female	473	90.7		91.7		86.2
Age (year)
<55y	881	92.8	0.15	88.5	0.60	82.5	0.01
≥55y	871	91.6		86.8		73.4
LDH(year)
≤245	1634	92.0	0.02	88.3	<0.01	82.0	<0.01
>245	107	83.1		74.5		61.9
Maximal diameter (cm)
≤2.5	1188	92.1	0.85	89.4	<0.01	83.4	<0.01
>2.5	564	91.6		81.5		72.8
Number of node
≤3	937	93.4	0.03	91.3	<0.01	86.0	<0.01
>3	915	88.3		80.0		70.9
CNN
Yes	768	88.7	0.01	80.8	<0.01	70.8	<0.01
No	984	93.6		91.9		88.6
ENE
Yes	825	89.4	0.02	79.8	<0.01	71.7	<0.01
No	927	93.5		90.1		86.7
T stage
T1	92	98.8	<0.01	95.6	<0.01	95.6	<0.01
T2	430	93.9		93.5		87.4
T3	872	93.7		86.4		80.8
T4	358	81.3		80.0		68.4
N stage
N1	837	93.4	0.91	92.2	<0.01	86.9	<0.01
N2	597	92.5		87.9		81.0
N3	315	91.4		71.8		63.7
Clinical stage
II	264	94.9	<0.01	96.4	<0.01	93.0	<0.01
III	852	94.6		90.5		85.5
IVa+b	836	85.7		78.1		69.1
Chemotherapy
Yes	1492	92.7	0.76	86.5	<0.01	70.9	0.07
No	260	91.3		92.1		79.5

Table 2 Failure Patterns in Nasopharyngeal Carcinoma (NPC) Patients

Failure Pattern	ENE(+)(No.)	ENE(-)(No.)	P value	CNN(+)(No.)	CNN(-)(No.)	P value
Local-regional failure
Local only	66	53		62	57
Regional only	30	8		27	11
Local+regional	2	2		3	1
Total	98	63	0.02	92	69	0.04
Distant metastasis
Bone only	43	22		53	12
Lung only	30	20		31	19
Liver only	26	9		22	13
Other single organ	5	3		6	2
Multiple organs	47	16		52	11
Total	151	70	<0.01	164	57	<0.01
Cause of death
Distant metastasis	140	53		136	57
Local/regional failure	55	44		58	41
Complications	8	6		10	4
Other cancers	10	8		12	6
Internal medication	6	2		7	1
Unknown	10	5		12	3
Total	229	118	<0.01	232	115	<0.01

Figure 2 Kaplan–Meier curves showing (A) DSS and (B) DMFS for the CNN and non-CNN groups.

Figure 3 Kaplan–Meier curves showing (A) DSS and (B) DMFS for the ENE and non-ENE groups.

Table 3 Multivariate Analysis of Prognostic Factors

Variables	HR Value	95% CI	P value
DSS
Age	1.47	1.20–1.80	0.01
Gender	1.35	1.06–1.73	<0.01
LDH	1.64	1.19–2.24	0.01
CNN	1.78	1.39–2.26	<0.01
ENE	1.43	1.10–1.85	<0.01
T stage	1.81	1.53–2.08	0.01
N stage	1.42	1.23–1.63	<0.01
OS
Age	1.62	1.33–1.97	<0.01
Gender	1.35	1.07–1.70	0.01
LDH	1.58	1.16–2.15	0.01
CNN	1.64	1.31–2.07	<0.01
ENE	1.33	1.05–1.70	<0.01
T stage	1.78	1.56–2.04	0.01
N stage	1.41	1.24–1.62	<0.01
PFS
Gender	1.52	1.17–1.96	0.01
LDH	1.58	1.45–2.05	0.03
CNN	1.71	1.33–2.17	<0.01
ENE	1.39	1.07–1.81	<0.01
T stage	1.60	1.39–1.84	0.01
N stage	1.34	1.16–1.55	<0.01
DMFS
Gender	1.60	1.13–2.26	0.01
T stage	1.72	1.42–2.08	<0.01
N stage	1.62	1.34–1.96	0.01
CNN	1.81	1.29–2.55	<0.01
ENE	1.60	1.11–2.30	<0.01
LRFS
T stage	2.05	1.62–2.68	<0.01
LDH	1.81	1.07–3.06	0.01
CNN	1.57	1.62–2.20	0.01
RRFS
N stage	1.58	1.12–2.51	<0.01
CNN	4.20	2.09–8.45	<0.01

Figure 4 Nomogram (A) (without nodal features) and nomogram (B) (with nodal features) developed for the 5- and 10-year prediction of disease-specific survival (DSS).

Figure 5 The calibration curve for predicting the 5- and 10-year DSS with nomogram (A) and nomogram (B).