709例鼻咽癌颈部各区淋巴结转移的相关性分析

背景与目的：基于鼻咽癌颈部各区淋巴结转移相关性的放疗临床靶区（clinical target volume，CTV）勾画研究尚未见报道。回顾性分析709例鼻咽癌患者颈部各区淋巴结转移间的相关性，为鼻咽癌基于颈部各区淋巴结转移相关性的放疗靶区勾画提出初步意见。方法：纳入2011年12月—2018年6月在西部战区总医院经病理学检查确诊并伴有颈部淋巴结转移的鼻咽癌患者709例，基于2013年新版《头颈部肿瘤颈部淋巴结分区指南》分析颈部各区淋巴结转移与其余各淋巴结区之间的相关性，采用χ ² 检验和logistic回归模型进行分析。结果：淋巴结转移概率最高的前4位依次是：Ⅱb（82.79%）、Ⅶa（82.65%）、Ⅱa（60.50%）、Ⅲ区（43.86%），相关性分析显示，Ⅰb区淋巴结转移与Ⅱa、Ⅲ区相关，Ⅱa区淋巴结转移与Ⅰb、Ⅱb、Ⅲ、Ⅴa、Ⅴc区相关，Ⅱb区淋巴结转移与Ⅱa、Ⅲ、Ⅳa、Ⅴa、Ⅴb、Ⅶa区相关，Ⅲ区淋巴结转移与Ⅱa、Ⅱb、Ⅳa、Ⅴa、Ⅴb、Ⅴc、Ⅶa区相关，Ⅳa区淋巴结转移与Ⅱa、Ⅱb、Ⅲ、Ⅳb、Ⅴa、Ⅴc区相关，Ⅳb区淋巴结转移与Ⅳa区相关，Ⅴa区淋巴结转移与Ⅱb、Ⅲ、Ⅳa、Ⅴb区、Ⅴ区后缘间隙（posterior to level Ⅴ，PLV）相关，Ⅴb区淋巴结转移与Ⅲ、Ⅴa、Ⅴc区、PLV相关，Ⅴc区淋巴结转移与Ⅱa、Ⅲ、Ⅳa、Ⅴb区、PLV相关，Ⅶa区淋巴结转移与Ⅱb、Ⅲ区相关，PLV淋巴结转移与Ⅴa、Ⅴb、Ⅴc区相关（P均＜0.05）。结论：鼻咽癌颈部淋巴结转移建立在上一站淋巴结转移的基础之上，基于颈部各区淋巴结转移相关性的靶区勾画可以减少中危CTV的照射范围。

Correlation analysis of neck node levels in 709 cases of nasopharyngeal carcinoma

Background and purpose:?The research on radiotherapy clinical target volume (CTV) delineation based on the correlation analysis between neck node levels of nasopharyngeal carcinoma has not been reported. We retrospectively analyzed 709 cases of nasopharyngeal carcinoma with cervical lymph node metastasis, and aimed to provide a preliminary opinion for the CTV delineation of nasopharyngeal carcinoma based on the correlation analysis of node involvement in each neck node level. Methods: Based on the 2013 updated guideline of delineation of the neck node levels for head and neck tumors, we analyzed 709 nasopharyngeal carcinoma patients with cervical lymph node metastasis in the General Hospital of Western Theater Command from December 2011 to June 2018. The correlations between different levels were studied using χ ² test and logistic regression model. Results: The top four node levels with the highest probability of metastasis were level Ⅱb (82.79%), level Ⅶa (82.65%), level Ⅱa (60.50%) and level Ⅲ (43.86%). Correlation analysis showed the lymph node metastasis in level Ⅰb was correlated with level Ⅱa and Ⅲ, level Ⅱa was correlated with level Ⅰb, Ⅱb, Ⅲ, Ⅴa and Ⅴc, level Ⅱb was correlated with level Ⅱa, Ⅲ, Ⅳa, Ⅴa, Ⅴb and Ⅶa, level Ⅲ was correlated with level Ⅱa, Ⅱb, Ⅳa, Ⅴa, Ⅴb, Ⅴc and Ⅶa, level Ⅳa was correlated with level Ⅱa, Ⅱb, Ⅲ, Ⅳb, Ⅴa and Ⅴc, level Ⅳb was correlated with level Ⅳa, level Ⅴa was correlated with level Ⅱb, Ⅲ, Ⅳa, Ⅴb and posterior to level Ⅴ (PLV), level Ⅴb was correlated with level Ⅲ, Ⅴa, Ⅴc and PLV, level Ⅴc was correlated with level Ⅱa, Ⅲ, Ⅳa, Ⅴb and PLV, levelⅦa was correlated with level Ⅱb and Ⅲ, and the PLV region was correlated with level Ⅴa, Ⅴb and Ⅴc (all P＜0.05). Conclusion: The lower cervical node involvement is based on the lymph node metastasis of upper levels. The delineation of intermediate risk CTV can be reduced based on the correlation analysis of neck node levels.