鼻咽癌淋巴结转移规律的Meta分析

doi:10.3760/cma.j.issn.1673-422X.2015.02.008

摘要/Abstract

摘要： 目的通过已经发表的文献来研究鼻咽癌淋巴结转移的规律和可能性，以建立一个描绘和选择N0、N1期鼻咽癌颈部淋巴结范围的适形放疗标准。方法检索万方、CBM、PubMed、Cochrane Library数据库收集以MRI为主要或者唯一影像学诊断方式的鼻咽癌临床试验，提取数据，采用Stata12.0进行Meta分析。结果从963篇原始文献中，纳入21篇临床试验，最常见的淋巴结转移区域为咽后淋巴结（67%）和Ⅱ区淋巴结（71%）；Ⅲ、Ⅳ、Ⅴ区淋巴结转移率分别为37%、14%、21%；低转移率淋巴结区包括ⅠA、ⅠB、Ⅵ和腮腺淋巴结，转移率分别为0、2%、2%、1%。淋巴结转移规律是自上而下循序性扩展，而跳跃性转移的可能性在0.5%～7.9%之间。结论鼻咽癌淋巴结转移存在一个可以预期的循序性转移规律，并且跳跃性转移是非常罕见的，以此证实了鼻咽癌N0、N1期治疗以适形放疗减少射野的方式是可行的。

关键词: 鼻咽肿瘤, 淋巴转移, Meta分析

Abstract: ObjectiveBased on the published articles, this paper aims to study the pattern and probability of lymph nodes metastasis in nasopharyngeal carcinoma (NPC) and establish a radiotherapy standard for selecting and delineation of clinical target volume of neck lymphatics for NPC patients with N0 or N1.MethodsClinical trials about NPC by MRI as the main or only diagnostic imaging way were collected and extracted from database, such as WanFang, CBM, PubMed, Cochrane Library. Statistical analyses were performed using Stata software, version 12.0. ResultsTwentyone clinical trials from 963 original articles were included in this analysis. The most commonly involved regions included retropharyngeal (67%) and level Ⅱ lymph nodes (71%). The overall probability of levels Ⅲ, Ⅳ and Ⅴnodal involvement were 37%, 14% and 21%, respectively. Lowrisk node groups included levels ⅠA, ⅠB, Ⅵ nodes, and the rates of lymph node metastasis were 0, 2%, 2% and 1%, respectively. Nodal metastases followed an orderly pattern of topdown, and the probability of "skip" metastasis between levels varied between 0.5%～7.9%. ConclusionLymph node metastasis in NPC follows a predictable and orderly pattern. The rarity of metastasis in certain nodal groups and "skip" metastasis suggest that reduced treatment volume is feasible in conformal radiotherapy for NPC patients with N0 or N1.

Key words: Nasopharyngeal neoplasms, Lymphatic metastasis, Meta-analysis

许超,包赟,周菊英,涂彧. 鼻咽癌淋巴结转移规律的Meta分析[J]. 国际肿瘤学杂志, 2015, 42(2): 109-114.

Xu Chao, Bao Yun, Zhou Juying, Tu Yu. Meta analysis of lymph node metastasis pattern of nasopharyngeal carcinoma[J]. Journal of International Oncology, 2015, 42(2): 109-114.

参考文献

［1］ Sham JS, Choy D, Wei WI. Nasopharyngeal carcinoma: orderly neck node spread［J］. Int J Radiat Oncol Biol Phys, 1990, 19(4): 929-933. ［2］杨忠，徐坚民，黄国鑫, 等. 从MRI的表现探讨鼻咽癌生长方式及淋巴结转移的规律［J］. 新乡医学院报, 2001, 18（6）: 399-401. ［3］钟伟铭，梁锦辉，高健全, 等. 鼻咽癌淋巴结转移规律的MRI分析［J］. 现代肿瘤学, 2007, 15（10）: 1399-1402. ［4］胡伟汗，张国义，刘立志, 等. PETCT与MRI诊断鼻咽癌淋巴结转移的对比研究［J］. 癌症, 2005, 24(7): 855-860. ［5］ Lv J, Wang R, Qing Y, et al. Magnetic resonance imaging analysis of regional lymph node metastasis in 1298 cases of nasopharyngeal carcinoma［J］. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 2012, 26(18): 769-772. ［6］ Ng SH, Chang JT, Chan SC, et al. Nodal metastases of nasopharyngeal carcinoma: patterns of disease on MRI and FDG PET［J］. Eur J Nucl Med Mol Imaging, 2004, 31(8): 1073-1080. ［7］ Liu LZ, Zhang GY, Xie CM, et al. Magnetic resonance imaging of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma: patterns of spread［J］. Int J Radiat Oncol Biol Phys, 2006, 66(3): 721-730. ［8］崔春燕, 李立, 刘学文. 应用磁共振成像技术探讨鼻咽癌咽后淋巴结转移的规律［J］. 中华肿瘤杂志, 2007, 29(10): 754-758. ［9］陈奇松, 林少俊, 潘建基, 等. 779例鼻咽癌颈部淋巴结转移规律分析［J］. 中国癌症杂志, 2010, 20(1): 50-54. ［10］覃玉桃, 张日光, 阮林, 等. 333例鼻咽癌咽后淋巴结转移特点的MRI分析［J］. 肿瘤防治研究, 2013, 40(9): 848-852. ［11］ Tang L, Mao Y, Liu L, et al. The volume to be irradiated during selective neck irradiation in nasopharyngeal carcinoma: analysis of the spread patterns in lymph nodes by magnetic resonance imaging［J］. Cancer, 2009, 115(3): 680-688. ［12］ Gregoire V, Levendag P, Ang KK, et al. CTbased delineation of lymph node levels and related CTVs in the nodenegative neck: DAHANCA, EORTC,GORTEC, NCIC, RTOG consensus guidelines［J］. Radiother Oncol, 2003, 69(3): 227-236. ［13］王丹, 牟振云, 翟俊霞, 等. Stata软件在Meta分析发表性偏倚识别中的探讨［J］. 现代预防医学, 2008, 35(15): 2819-2822. ［14］ Wang X, Li L, Hu C, et al. Patterns of level Ⅱ node metastasis in nasopharyngeal carcinoma［J］. Radiother Oncol, 2008, 89(1): 28-32. ［15］ Liao XB, Mao YP, Liu LZ, et al. How does magnetic resonance imaging influence staging according to AJCC staging system for nasopharyngeal carcinoma compared with computed tomography?［J］. Int J Radiat Oncol Biol Phys, 2008, 72(5): 1368-1377. ［16］ Ng SH, Chang TC, Ko SF, et al. Nasopharyngeal carcinoma: MRI and CT assessment［J］. Neuroradiology, 1997, 39(10): 741-746. ［17］ Wolden SL, Chen WC, Pfister DG, et al. Intensitymodulated radiation therapy (IMRT) for nasopharynx cancer: update of the Memorial SloanKettering experience［J］. Int J Radiat Oncol Biol Phys, 2006, 64(1): 57-62. ［18］ King AD, Ahuja AT, Leung SF, et al. Neck node metastases from nasopharyngeal carcinoma: MR imaging of patterns of disease［J］. Head Neck, 2000, 22(3): 275-281. ［19］ Ng WT, Lee AW, Kan WK, et al. Nstaging by magnetic resonance imaging for patients with nasopharyngeal carcinoma: pattern of nodal involvement by radiological levels［J］. Radiother Oncol, 2007, 82(1): 70-75. ［20］ Fuwa N, Ariji Y, Daimon T, et al. Relationship between the growth pattern of nasopharyngeal cancer and the cervical lymph nodes based on MRI findings: can the cervical radiation field be reduced in patients with nasopharyngeal cancer?［J］. Br J Radiol, 2006, 79(945): 725-729. ［21］ Lu JC, Wei BQ, Chen WZ, et al. Staging of nasopharyngeal carcinoma investigated by magnetic resonance imaging［J］. Radiother Oncol, 2006, 79(1): 21-26. ［22］ Lam WW, Chan YL, Leung SF, et al. Retropharyngeal lymphadenopathy in nasopharyngeal carcinoma［J］. Head Neck, 1997, 19(3): 176-181. ［23］ Chong VF, Fan YF, Khoo JB. Retropharyngeal lymphadenopathy in nasopharyngeal carcinoma［J］. Eur J Radiol, 1995, 21(2): 100-105. ［24］ Kam MK, Teo PM, Chau RM, et al. Treatment of nasopharyngeal carcinoma with intensitymodulated radiotherapy: the Hong Kong experience［J］. Int J Radiat Oncol Biol Phys, 2004, 60(5): 1440-1450. ［25］林志雄, 杨志宁, 詹益州, 等. 鼻咽癌2008分期应用的研究［J］. 癌症, 2009, 28(10): 1029-1032. ［26］ Som PM, Curtin HD, Mancuso AA. Imagingbased nodal classification for evaluation of neck metastatic adenopathy［J］. AJR Am J Roentgenol, 2000, 174(3): 837-844. ［27］ Castelijns J, van den Brekel M. Imaging of lymphadenopathy in the neck［J］. Eur Radiol, 2002, 12(4): 727-738.

[1]	许凤琳, 吴刚. EBV在鼻咽癌肿瘤免疫微环境和免疫治疗中的研究进展[J]. 国际肿瘤学杂志, 2024, 51(6): 359-363.
[2]	崔腾璐, 孙鹏飞. 鼻咽低级别乳头状腺癌综合治疗1例并文献复习[J]. 国际肿瘤学杂志, 2023, 50(6): 382-384.
[3]	顾安琴, 龙金华, 金风. 鼻咽癌免疫治疗的临床研究进展[J]. 国际肿瘤学杂志, 2023, 50(5): 299-303.
[4]	曾利武, 杜雨强, 张鹏, 陶凯雄. 直肠癌侧方淋巴结转移的影像评估进展[J]. 国际肿瘤学杂志, 2023, 50(4): 248-251.
[5]	中华医学会数字医学分会, 重庆市医学会放射肿瘤治疗学专业委员会, 重庆市中西医结合学会肿瘤放疗专业委员会, 重庆市抗癌协会肿瘤放疗专业委员会. 鼻咽癌调强放疗靶区勾画重庆共识之原发灶与靶区设计[J]. 国际肿瘤学杂志, 2022, 49(12): 705-710.
[6]	李劲浩, 王桂东, 李雪菲, 刘子琳, 孟凯龙. 静脉期CT值预测甲状腺乳头状癌中央组淋巴结转移的临床研究[J]. 国际肿瘤学杂志, 2022, 49(10): 581-585.
[7]	陈方明, 蔡园园, 李晗, 王晓丽, 阚红星, 李洋, 郝福荣, 王明臣. 调强放疗鼻咽癌患者UICC第7版与第8版T分期预后差异[J]. 国际肿瘤学杂志, 2021, 48(9): 515-522.
[8]	彭亚, 柳岸, 刘火旺. PSD-007光动力疗法对荷人鼻咽癌裸鼠移植瘤的抑制作用及机制研究[J]. 国际肿瘤学杂志, 2021, 48(3): 136-142.
[9]	宋扬, 王斌, 肖何, 陈川, 王阁, 耿明英. 局部晚期鼻咽癌诱导化疗后肿瘤退缩率对患者生存的预测价值[J]. 国际肿瘤学杂志, 2021, 48(3): 156-163.
[10]	朱雷, 黄剑波. 治疗前血浆EB病毒DNA载量和不同治疗方式对Ⅲ期鼻咽癌疗效及预后的影响[J]. 国际肿瘤学杂志, 2021, 48(2): 74-79.
[11]	罗文肖, 吴德华, 蔡隆梅. 免疫疗效生物标志物在鼻咽癌治疗中的预测价值[J]. 国际肿瘤学杂志, 2021, 48(12): 743-746.
[12]	杨明慧, 金风. 3D-ASL、MRS及DTI对鼻咽癌放射性颞叶损伤的诊断及指导治疗价值[J]. 国际肿瘤学杂志, 2020, 47(9): 550-554.
[13]	杨超, 王建波, 张菊红, 王佳龙. 过表达miR-125通过下调FGF-2抑制鼻咽癌细胞增殖与侵袭[J]. 国际肿瘤学杂志, 2020, 47(5): 257-263.
[14]	沈建军. 鼻咽癌放疗后局部复发的治疗[J]. 国际肿瘤学杂志, 2020, 47(4): 227-230.
[15]	郭信伟, 张晗, 曹云, 周菊英, 刘阳晨, 叶宏勋, 冀胜军. NRS-2002对胸段食管鳞状细胞癌术后淋巴结转移放化疗患者疗效及预后的预测价值[J]. 国际肿瘤学杂志, 2020, 47(11): 663-668.