基于MRI的3100例鼻咽癌淋巴结转移规律分析  

Patterns of lymph node metastases from nasopharyngeal carcinoma： an analysis of 3100 patients based on MRI

作　　者：王孝深[1] 胡超苏[1] 应红梅[1] 何霞云[1] 沈春英[1] 朱国培[1] 孔琳[1] 丁建辉[2] 

机构地区：[1] 复旦大学上海医学院肿瘤学系复旦大学附属肿瘤医院放疗科,上海200032 [2] 复旦大学上海医学院肿瘤学系复旦大学附属肿瘤医院放射诊断科,上海200032

出　　处：《中华放射肿瘤学杂志》2014年第4期331-335,共5页Chinese Journal of Radiation Oncology

基　　金：上海市科学技术委员会基金资助（124119a6202）

摘　　要：目的 应用MRI研究鼻咽癌淋巴结转移规律,为IMRT提供颈部照射范围依据.方法 前瞻分析2010-2013年间具有MRI检查的3 100例初治鼻咽癌患者资料.由鼻咽癌多学科综合治疗组阅片,分析淋巴结转移.淋巴结位置按RTOG分区2003版评判.结果 全组淋巴结转移占86.42％（2 679/3100）,其中分布在咽后外侧组2012例（64.90％,其中6例同时位于中央组）,Ⅱb区2341例（75.52％,其中492例淋巴结上界至C1一半水平、115例到达颅底水平）,Ⅱa区1798例（58.00％）,Ⅲ区1 184例（38.19％）,Ⅳ区350例（11.29％,其中28例下界超出RTOG规定的范围）,Ⅴ区995例（32.10％,其中91例超出规定范围）,Ⅰ b区115例（3.71％）,腮腺区域40例（1.29％,均伴随同侧广泛淋巴结转移,且淋巴结总数≥6个）.只6例发生跳跃性转移（0.19％）.结论 ①鼻咽癌中央组咽后淋巴结转移较为罕见;②Ⅱ区淋巴结上界为颅底水平更合适;③鼻咽癌淋巴结转移从上至下规律性发展;④Ⅳ、Ⅴ区有转移时淋巴结可能超出RTOG规定范围;⑤同侧淋巴结广泛转移时可能出现腮腺区累及.Objective To investigate the patterns of lymph node metastases from nasopharyngeal carcinoma （NPC） based on magnetic resonance imaging （MRI） and to provide a basis for neck irradiation field in intensity-modulated radiation therapy.Methods From 2010 to 2013,3 100 patients newly diagnosed with NPC who underwent MRI were analyzed.All images were evaluated by the multi-disciplinary treatment group for NPC to analyze lymph node metastases.The locations of lymph nodes were determined by the RTOG consensus guidelines published in 2003.Results Of 3100 patients,2 679 （86.42％） had lymph node metastases; the detailed distribution was as follows：lateral retropharyngeal region （2012 patients,64.90％ ;6 patients were also in the medial group）,level Ⅱ b（2341 patients,75.52％ ;492 had the upper border reaching half of C1 vertebra and 115 had the upper border reaching the skull base）,level Ⅱ a（1798 patients,58.00％）,level Ⅲ （1 184 patients,38.19％）,level Ⅳ （350 patients,11.29％ ;28 had the lower border beyond the RTOG recommended boundary）,level Ⅴ （995 patients,32.10％ ;91 had the lymph nodes beyond the RTOG recommended boundary）,level Ⅰ b （115 patients,3.71％）,and parotid region （40 patients,1.29％）.Extensive ipsilateral lymph node metastases were seen in patients with lymph nodes metastases in levels Ⅳ and Ⅴ,and the total numbers of involved nodes were ≥ 6 and 7.Skip metastasis occurred in 6 patients （0.19％）.Conclusions Metastases to retropharyngeal lymph nodes are seen mainly in the lateral group but rarely in the medial group.The upper border of level Ⅱ lymph nodes should be the skull base.Lymph node metastases from NPC are in an orderly manner,and skip metastasis is rarely seen.When level Ⅳ/Ⅴ lymph nodes are involved,there might exist metastases beyond the RTOG recommended boundary.In case of extensive ipsilateral lymph node metastases,the parotid region might be involved.

关 键 词：鼻咽肿瘤 磁共振成像 淋巴结转移 淋巴结分区 

分 类 号：R739.63[医药卫生—肿瘤] R730.55[医药卫生—临床医学]