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Published on: August 19, 2021
Prognostic Significance of Cervical Lymph Node Biopsy in Nasopharyngeal Carcinoma Patients: A Retrospective Analysis
Ru Sang1, Zaixiang Tang2, Xiaoting Xu1
1Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, People's Republic of China.
Background:
The impact of cervical lymph node biopsy on survival, distant metastasis, and local recurrence in nasopharyngeal carcinoma (NPC) patients remains controversial. This study aims to compare the effects of cervical lymph node biopsy and nasopharyngeal biopsy on these outcomes.
Methods:
This retrospective study enrolled NPC patients treated at the First Affiliated Hospital of Soochow University between January 2013 and December 2021. Kaplan-Meier method was used to evaluate the overall survival (OS), distant metastasis-free survival (DMFS), locoregional recurrence-free survival (LRFS), nodal recurrence-free survival (NRFS), and progression-free survival (PFS), with comparisons using the Log rank test. Univariate and multivariate Cox regression models were used to identify independent prognostic factors.
Results:
A total of 721 NPC patients who underwent radiotherapy were retrospectively analyzed. Among them, 591 were diagnosed with nasopharyngeal biopsy, and 130 patients with cervical lymph node metastasis suspected to originate from NPC underwent confirmatory nasopharyngeal biopsy. In cervical lymph node biopsy, 36 had excisional biopsies, 85 had fine needle aspirations, and 9 cases were unspecified. Survival was not significantly different between patients with nasopharyngeal biopsy and cervical lymph node biopsy (5-year OS: 81.1% vs 85.0%; DMFS: 75.2% vs 80.6%; LRFS: 79.5% vs 78.7%; NRFS: 80.4% vs 80.4%; PFS: 74.3% vs 74.3%; all p>0.05). Results were similar for the propensity-matched cohort of 260 patients.Additionally, survival was not significantly different between the fine needle aspiration and excision biopsy groups (5-year OS: 85.1% vs 83.5%; DMFS: 79.7% vs 80.3%; LRFS: 85.2% vs 74.8%; NRFS: 85.1% vs 77.7%; PFS: 79.8% vs 71.7%; all p>0.05). Targeted therapy and >3 cycles of chemotherapy were prognostic factors in NPC patients (p<0.05).
Conclusion:
Cervical lymph node biopsy did not increase the risk of locoregional recurrence, distant metastasis, or death in NPC patients.
