Advanced image-identified extranodal extension of retropharyngeal lymph nodes in the refinement of N classification for nasopharyngeal carcinoma
Advanced extranodal extension (ENE) in cervical lymph nodes (CLNs) increases the risk of distant metastasis in nasopharyngeal carcinoma (NPC). The 9th NPC staging system classifies N1/N2 patients with advanced CLN ENE as N3 due to similar outcomes. However, the prognostic impact of advanced ENE in retropharyngeal lymph nodes (RLNs) remains unclear. In this study of 4,485 patients with non-metastatic NPC, N1/N2 patients with advanced RLN ENE demonstrate better 5-year overall survival (hazard ratio [HR]: 0.60, 95% confidence interval [CI]: 0.38-0.93; HR: 0.57, 95% CI: 0.32-1.00) and failure-free survival (HR: 0.63, 95% CI: 0.44-0.92; HR: 0.52, 95% CI: 0.31-0.86) than N3 patients. Advanced RLN ENE shows a positive correlation with other RLN-related anatomical factors and is not identified as an independent prognostic factor. External validation in 3,849 patients from five centers supports these findings. Based on this evidence, upgrading advanced RLN ENE to N3 is not advised.
Authors
- Liangfang Shen (ORCID: https://orcid.org/0000-0001-9474-6329)
- Jibin Li (ORCID: https://orcid.org/0000-0001-7632-3648)
- Xiaojing Du (ORCID: https://orcid.org/0000-0001-8228-5086)
- Guiqiong Xu (ORCID: https://orcid.org/0000-0001-5093-3421)
- Lizhi Liu (ORCID: https://orcid.org/0000-0003-0199-6308)
- Qin Zhou (ORCID: https://orcid.org/0000-0003-3879-4021)
- Gaoyuan Wang (ORCID: https://orcid.org/0000-0003-4039-748X)
- Wei Jiang (ORCID: https://orcid.org/0000-0002-4870-5005)
- Guanjie Qin (ORCID: https://orcid.org/0000-0002-5103-3641)
- Jing Huang (ORCID: https://orcid.org/0000-0001-9820-7648)
- Ling‐Long Tang (ORCID: https://orcid.org/0000-0002-8561-1454)
- Kunyu Yang (ORCID: https://orcid.org/0000-0002-2575-4736)
- Yan‐Ping Mao (ORCID: https://orcid.org/0000-0003-1027-071X)
- Lei Chen (ORCID: https://orcid.org/0009-0003-4906-5163)
- Jun Ma (ORCID: https://orcid.org/0000-0002-1137-9349)
- Lei Feng (ORCID: https://orcid.org/0000-0002-6449-0307)
- Ling Li (ORCID: https://orcid.org/0000-0001-5358-4968)
- Wenjun Zhang (ORCID: https://orcid.org/0000-0001-7973-8769)
- Shao Hui Huang (ORCID: https://orcid.org/0000-0002-8072-4388)
- Yaqian Han (ORCID: https://orcid.org/0009-0005-7733-3799)
- Chunyan Cui (ORCID: https://orcid.org/0000-0001-8578-6425)
- Rui Guo (ORCID: https://orcid.org/0000-0003-1683-0837)
- Xiao‐Dong Zhu (ORCID: https://orcid.org/0000-0001-9864-6763)
- Zheng Wu (ORCID: https://orcid.org/0009-0007-5885-4999)
Institutions
- Union Hospital (HK)
- Central South University (CN)
- Sun Yat-sen University (CN)
- Guangxi Medical University (CN)
- University of Toronto (CA)
- Princess Margaret Cancer Centre (CA)
- Zhongshan People's Hospital (CN)
- Hunan Cancer Hospital (CN)
- Sun Yat-sen University Cancer Center (CN)
- Xiangya Hospital Central South University (CN)
- Huazhong University of Science and Technology (CN)
Publication Details
- Journal
- Cell Reports Medicine
- Published
- 2025-02-01
- DOI
- https://doi.org/10.1016/j.xcrm.2025.101942
- Citations
- 3
- Primary Topic
- Head and Neck Cancer Studies
- Type
- article
- Field-Weighted Citation Impact
- 5.54
Funders
- National Natural Science Foundation of China
- Sun Yat-sen University
- Sun Yat-sen University Cancer Center