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Retropharyngeal Lymph Node Metastasis in Nasopharyngeal Carcinoma: Prognostic Value and Staging Categories

Authors' Affiliations: State Key Laboratory of Oncology in Southern China, ¹ Department of Radiation Oncology and ² Imaging Diagnosis and Interventional Center, Cancer Center and ³ Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China

Requests for reprints: Li Li, State Key Laboratory of Oncology in Southern China, Imaging Diagnosis and Interventional Center, Cancer Center, Sun Yat-sen University, 651 Dongfeng Dong Road, Guangzhou 510060, Guang Dong, People's Republic of China. Phone: 86-20-87343217; Fax: 86-20-87343295; E-mail: li2{at}mail.sysu.edu.cn.

Purpose: To investigate the incidence, prognostic value, and staging categories of retropharyngeal lymph node (RLN) metastasis in nasopharyngeal carcinoma (NPC).

Experimental Design: We did a retrospective review of the data from 749 biopsy-proved nonmetastatic NPC patients. All patients had undergone contrast-enhanced computed tomography and had radiotherapy as their primary treatment.

Results: The incidence of RLN metastasis was 51.5%. After adjusting for tumor (T) and node (N) classifications, a borderline significant difference of distant metastasis-free survival (DMFS) rates was observed between patients with or without RLN metastasis. In N₀ disease, the presence of RLN metastasis was a significant independent predictor for overall survival (OS), loco-regional relapse-free survival, and DMFS in multivariate Cox modeling analysis. No significant difference was observed in all end points between patients with unilateral and bilateral RLN metastasis. The hazard ratios of death and distant failure for N₀ with RLN metastasis were similar to N₁. The survival curve of OS and DMFS for N₀ disease with RLN metastasis had approximated that of N₁ disease. The survival curve of OS for T₁ disease with RLN metastasis was approximately the same as T₂ disease. However, the survival curve of DMFS for T₁ disease with RLN metastasis was approximately the same as in T₃ disease.

Conclusions: RLN metastasis has a tendency to affect the DMFS rates of patients with NPC. Retropharyngeal node involvement has a negative effect on the prognosis of N₀ disease. RLN metastasis should be classified as N₁.