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Ai QYH, Hung KF, So TY, Mo FKF, Tsung Anthony Chin W, Hui EP, Ma BBY, Ying M, King AD. Prognostic value of cervical nodal necrosis on staging imaging of nasopharyngeal carcinoma in era of intensity-modulated radiotherapy: a systematic review and meta-analysis. Cancer Imaging 2022; 22:24. [PMID: 35596198 PMCID: PMC9123677 DOI: 10.1186/s40644-022-00462-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/13/2022] [Indexed: 12/02/2022] Open
Abstract
Purposes To systematically review and perform meta-analysis to evaluate the prognostic value of cervical nodal necrosis (CNN) on the staging computed tomography/magnetic resonance imaging (MRI) of nasopharyngeal carcinoma (NPC) in era of intensity-modulated radiotherapy. Methods Literature search through PubMed, EMBASE, and Cochrane Library was conducted. The hazard ratios (HRs) with 95% confidence intervals (CIs) of CNN for distant metastasis-free survival (DMFS), disease free survival (DFS) and overall survival (OS) were extracted from the eligible studies and meta-analysis was performed to evaluate the pooled HRs with 95%CI. Results Nine studies, which investigated the prognostic values of 6 CNN patterns on MRI were included. Six/9 studies were eligible for meta-analysis, which investigated the CNN presence/absence in any nodal group among 4359 patients. The pooled unadjusted HRs showed that the CNN presence predicted poor DMFS (HR =1.89, 95%CI =1.72-2.08), DFS (HR =1.57, 95%CI =1.08-2.26), and OS (HR =1.87, 95%CI =1.69-2.06). The pooled adjusted HRs also showed the consistent results for DMFS (HR =1.34, 95%CI =1.17-1.54), DFS (HR =1.30, 95%CI =1.08-1.56), and OS (HR =1.61, 95%CI =1.27-2.04). Results shown in the other studies analysing different CNN patterns indicated the high grade of CNN predicted poor outcome, but meta-analysis was unable to perform because of the heterogeneity of the analysed CNN patterns. Conclusion The CNN observed on the staging MRI is a negative factor for NPC outcome, suggesting that the inclusion of CNN is important in the future survival analysis. However, whether and how should CNN be included in the staging system warrant further evaluation.
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Affiliation(s)
- Qi-Yong H Ai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong S.A.R., P.R. China. .,Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong S.A.R., P.R. China.
| | - Kuo Feng Hung
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong, Hong Kong S.A.R., P.R. China
| | - Tiffany Y So
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong S.A.R., P.R. China
| | - Frankie K F Mo
- Department of Clinical Oncology, State Key Laboratory in Oncology in South China, The Chinese University of Hong Kong, Prince of Wales Hospital, Sir Y.K. Pao Centre for Cancer, New Territories, Hong Kong S.A.R., P.R. China
| | - Wing Tsung Anthony Chin
- Department of Radiology and Organ Imaging, United Christian Hospital, Kowloon, Hong Kong S.A.R., P.R. China
| | - Edwin P Hui
- Department of Clinical Oncology, State Key Laboratory in Oncology in South China, The Chinese University of Hong Kong, Prince of Wales Hospital, Sir Y.K. Pao Centre for Cancer, New Territories, Hong Kong S.A.R., P.R. China
| | - Brigette B Y Ma
- Department of Clinical Oncology, State Key Laboratory in Oncology in South China, The Chinese University of Hong Kong, Prince of Wales Hospital, Sir Y.K. Pao Centre for Cancer, New Territories, Hong Kong S.A.R., P.R. China
| | - Michael Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong S.A.R., P.R. China
| | - Ann D King
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong S.A.R., P.R. China
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