Study On Clinical Features And Prognostic Factors Of Head And Neck Carcinomas

Part ⅠHigh-risk Factors of Retropharyngeal Lymph Node Metastasis in Patients with Hypopharyngeal Carcinoma Based on Magnetic Resonance ImagingPurpose The aim of this retrospective study was to analyze the incidence and high-risk factors of lymph node metastasis in the retropharyngeal region of hypopharyngeal squamous cell carcinoma based on magnetic resonance imaging(MRI)to guide clinical target area delineation.Methods This study included 326 patients who were diagnosed with hypopharyngeal carcinoma from 2012 to 2018.Each patient’s lymph node metastasis diagnosis and target delineation of primary gross target volume(GTVp)and lymph nodes target volume(GTVnd)was determined by all the radiation oncologists in head and neck group through twice weekly general rounds discussion.The cut off point was defined by establishing the receiver operating characteristic curve(ROC),and patients were divided into high GTVp group,low GTVp group and high GTVnd group or low GTVnd group.Chi-square test was used for univariate analysis and logistic regression was used for multivariate analysis to analyze the high-risk factors of patients with retropharyngeal lymph node metastasis.Results The overall metastatic rate of cervical lymph nodes in all patients in this study was 90.5%.The most common involved area was Level Ⅱa,followed by Level Ⅲ,LevelⅡb,Level IV,Level Ⅶa(retropharyngeal),Level Va,and Level Vb.The incidence of retropharyngeal lymph node metastasis was 21.5%,and the incidence was 53.1%in patients with primary tumor located in the posterior pharyngeal wall.Univariate and multivariate analysis showed that patients with tumor originated in the posterior pharyngeal wall(p=0.002),bilateral cervical lymph node metastasis(p=0.020),larger GTVp(greater than 47cc,p=0.003),and larger GTVnd(Greater than 22cc,p=0.023)was significantly associated with the occurrence of retropharyngeal lymph node metastasis.Conclusions Our study revealed that the incidence of retropharyngeal lymph node metastasis is high in hypopharyngeal cancer,especially in patients with primary tumors in the posterior pharyngeal wall,bilateral cervical lymph node metastasis and larger primary burden.Therefore,for patients with risk factors,it is highly recommended that the clinical target area be delineated to include the retropharyngeal lymph node drainage area.Part ⅡClinical Features,Diagnosis and Prognosis of Patients with Primary Parotid Lymphoepithelial CarcinomaPurpose The aim of this retrospective study was to analyze the clinical features,diagnose and prognosis of primary parotid lymphoepithelial carcinoma.Methods Clinical data of 13 cases of parotid lymphoepithelial carcinoma diagnosed in our hospital in 2009-2017 were retrospectively analyzed.The median follow-up time was 38.5 months,and all patients received radiotherapy after operation.The overall survival(OS)and progression-free survival(PFS)were calculated by Kaplan-Meier survival analysis.The prognostic factors were assessed by univariate analysis.Results Of 13 patients,9 cases were men,and the other 4 cases were female.The median age was 33 years.At the initial diagnosis,9 cases of primary lesion was limited to parotid gland,and other 4 cases had lymph node metastasis which were all located in Ib,Ⅱ region of the neck.According to UICC2010 staging,1 case was classified as stage I,1 as stage Ⅱ,6 as stage Ⅲ,and 5 as stage IV respectively.All the patients underwent surgery followed by postoperative radiotherapy.There were 11 cases of surgical pathology specimens were tested with EBER in-situ,and 10 cases were positive.The 3-year overall survival rate was 100%for no death during the follow-up time.The 3-year disease-free survival rate was 16.2%,the 3-year Local control rate 92.3%,and 3-year metastasis-free survival rate 83.9%.Univariate analysis demonstrated that the age,sex and staging were not independent prognostic factors.Conclusions The incidence of parotid lymphatic epithelial cancer is rare.The pathological features were associated with EB virus.It prone to present with cervical lymph node metastasis.The possibility of lymph node metastasis of nasopharyngeal carcinoma to the parotid gland should be excluded before treatment.At present,the common treatment mode is surgery combined with postoperative radiotherapy.The overall survival is favorable,the main failure patterns were local recurrence and distant metastasis.Advanced stage and only surgical treatment may be associated with poor prognosisPart ⅢThe Clinical significance of plasma Epstein-Barr virus DNA in nasopharyngeal carcinomaObjective It has been confirmed that Epstein-Barr virus(EBV)is associated with the occurrence and development of the nasopharyngeal carcinoma(NPC).We investigated the clinical significance of plasma concentrations of EBV-DNA in patients with NPC.Methods From October,2013 to December,2016,471 patients were analyzed.The significantly associated between EBV-DNA before treatment and staging,tumor burden was analyzed.The survival rate of EBV-DNA before and after treatment was calculated.Results The median copies of pretreatment plasma EBV-DNA in patients is 137 copies,(range 0-494 000),which is correlated with T stage,N stage,M stage,clinical stage and tumor burden load and that is statistically significant.Overall survival(OS,P=0.007),progression-free survival(PFS,P=0.011)and distant metastasis-free survival(DMFS,P=0.003)were significantly lower among patients with pretreatment plasma EBV-DNA more than 1 300 copies/ml.Patients with detectable plasma EBV-DNA had significantly worse OS(P=0.016),PFS(P=0.000)and DMFS(P=0.000)than patients with undetectable EBV-DNA after treatment.Cox multivariate analyze suggests that T stage and EBV-DNA after treatment were independent prognostic factors for OS,however the plasma EBV-DNA after treatment(P=0.006,0.001)and N stage(P=0.037,0.017)were independent prognostic factors for PFS and DMFS.Conclusions The plasma EBV-DNA level was significantly correlated with staging and tumor load before treatment in patients with NPC,and the prognosis of patients with higher copies before treatment could be worse.The plasma EBV-DNA after treatment is predictive for OS,PFS and DMFS.Part ⅣCirculating Lymphocyte Subsets as a Predictor of Distant Metastasis in Nasopharyngeal Cancer Patients Receiving Intensity modulated radiotherapyObjective This study aimed to evaluate the prognostic significance of circulating lymphocyte subsets in nasopharyngeal cancer(NPC)patients receiving intensity modulated radiotherapy(IMRT).Methods This study retrospectively analyzed the data of 290 non-metastatic NPC patients who received circulating lymphocyte subsets tests during radiotherapy.SurvivalROC software package was used to perform time-varying receiver operating characteristic(ROC)curves to study the prognostic value and optimal cut-off point of lymphocytes for distant metastasis-free survival(DMFS).Univariate and multivariate analyses were performed to validate risk factors of DMFS.Results Significant changes in the circulating lymphocyte subsets occurred during IMRT and still changed about 3 months after the end of IMRT.The 3-year progression-free survival(PFS)and DMFS rates for all patients were 78.5%and 84.6%,respectively.Time-dependent ROC and univariate analysis revealed that the DMFS rate was higher in patients with higher proportion of HLA-DR+T cells after treatment,higher proportion of CD8+CD28" T cells after treatment,higher CD8+T cells Ratio(after treatment/before treatment),higher CD8+CD28-T cells Ratio and higher plasma EBV DNA load before treatment.The multivariate analysis revealed that higher CD8+CD28" T cells Ratio was still significantly associated with higher distant metastasis risk.Conclusions The ratio of circulating CD8+CD28-T lymphocyte subset after treatment to pretreatment levels could be a valuable prognostic factor for distant metastasis risk in non-metastatic NPC patients treated with IMRT.