Prognostic potential of a voxelwise invasion risk map of nasopharyngeal carcinoma based on a coordinate system of the nasopharynx

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Abstract

Background

Tumor invasion risk (TIR) is an important prognostic factor in nasopharyngeal carcinoma (NPC). We propose a novel prognostic analytic method for NPC based on a voxelwise analysis of TIR in a coordinate system of the nasopharynx.

Methods

A stable nasopharynx coordinate system was constructed based on anatomical landmarks to obtain an accurate TIR profile for NPC. The coordinate system was validated by image registration of the lateral pterygoid muscle (LPM). The tumors were registered to the coordinate system through shift, scale, and rotation transformations. The voxelwise TIR map for NPC was obtained by superposition of all registered and mirrored tumor regions of interest. The minimum risk (MinR) point of the tumor region was used as an independent prognostic factor for NPC. The cutoff value was calculated with density plot and validated with restricted cubic splines (RCSs), and then the patients were divided into 2 groups for overall survival (OS) analysis.

Results

The first voxelwise TIR map of NPC was obtained based on 778 patients. The OS of patients with a low TIR was 76.8% and was 92.6% for patients with a high TIR [P<0.001; hazard ratio (HR) =1/0.45; 95% CI: 0.27–0.77; adjusted P=0.004]. Thus, patients with a low TIR had a poor prognosis, whereas patients with a high TIR had a good prognosis. The MinR may be better at grading the prognosis of patients compared to the American Joint Committee on Cancer (AJCC) staging or tumor/node (T/N) classification systems.

Conclusions

The voxelwise TIR map provides a new method for the prognostic analysis of NPC. Potential clinical applications of voxelwise TIR mapping are clinical target volume (CTV) delineation and dose-painting for NPC.

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Most cited references 62

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Perineural Invasion and Perineural Tumor Spread in Head and Neck Cancer: A Critical Review

Richard L. Bakst, Christine Glastonbury, Upendra Parvathaneni … (2018)

Perineural invasion (PNI), the neoplastic invasion of nerves, is a common pathologic finding in head and neck cancer that is associated with poor clinical outcomes. PNI is a histologic finding of tumor cell infiltration and is distinct from perineural tumor spread (PNTS), which is macroscopic tumor involvement along a nerve extending from the primary tumor that is by definition more advanced, being radiologically or clinically apparent. Despite widespread acknowledgment of the prognostic significance of PNI and PNTS, the mechanisms underlying its pathogenesis remain largely unknown, and specific therapies targeting nerve invasion are lacking. The use of radiation therapy for PNI and PNTS can improve local control and reduce devastating failures at the skull base. However, the optimal volumes to be delineated with respect to targeting cranial nerve pathways are not well defined, and radiation can carry risks of major toxicity secondary to the location of adjacent critical structures. Here we examine the pathogenesis of these phenomena, analyze the role of radiation in PNI and PNTS, and propose guidelines for radiation treatment design based on the best available evidence and the authors' collective experience to advance understanding and therapy of this ominous cancer phenotype.

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Locoregional extension patterns of nasopharyngeal carcinoma and suggestions for clinical target volume delineation

Wen-Fei Li, Ying Sun, Mo Chen … (2012)

Clinical target volume (CTV) delineation is crucial for tumor control and normal tissue protection. This study aimed to define the locoregional extension patterns of nasopharyngeal carcinoma (NPC) and to improve CTV delineation. Magnetic resonance imaging scans of 2366 newly diagnosed NPC patients were reviewed. According to incidence rates of tumor invasion, the anatomic sites surrounding the nasopharynx were classified into high-risk (>30%), medium-risk (5%–30%), and low-risk (<5%) groups. The lymph node (LN) level was determined according to the Radiation Therapy Oncology Group guidelines, which were further categorized into the upper neck (retropharyngeal region and level II), middle neck (levels III and Va), and lower neck (levels IV and Vb and the supraclavicular fossa). The high-risk anatomic sites were adjacent to the nasopharynx, whereas those at medium- or low-risk were separated from the nasopharynx. If the high-risk anatomic sites were involved, the rates of tumor invasion into the adjacent medium-risk sites increased; if not, the rates were significantly lower (P < 0.01). Among the 1920 (81.1%) patients with positive LN, the incidence rates of LN metastasis in the upper, middle, and lower neck were 99.6%, 30.2%, and 7.2%, respectively, and skip metastasis happened in only 1.2% of patients. In the 929 patients who had unilateral upper neck involvement, the rates of contralateral middle neck and lower neck involvement were 1.8% and 0.4%, respectively. Thus, local disease spreads stepwise from proximal sites to distal sites, and LN metastasis spreads from the upper neck to the lower neck. Individualized CTV delineation for NPC may be feasible.

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Extension of local disease in nasopharyngeal carcinoma detected by magnetic resonance imaging: improvement of clinical target volume delineation.

Li Tian, Ai-Hua Lin, Jun Ma … (2009)

To define by MRI the local extension patterns in patients presenting with nasopharyngeal carcinoma (NPC) and to improve clinical target volume delineation. Consecutive patients (N = 943) with newly diagnosed and untreated NPC were included in this study. All patients underwent MRI of the nasopharynx and neck, which was reviewed by two radiologists. According to the incidence rates of tumor invasion, the anatomic sites surrounding the nasopharynx were initially classified into three risk grades: high risk (> or = 35%), medium risk (> or = 5-35%), and low risk (< 5%). Incidence rates of tumor invasion into anatomic sites at medium risk were increased, reaching 55.2%, when adjacent high-risk anatomic sites were involved. However, the rates were substantially lower, mostly < 10%, when adjacent high-risk sites were not involved. The incidence rates of concurrent tumor invasion into bilateral sites were < 10%, except in the case of prevertebral muscle involvement (13.1%). Among the 178 incidences of cavernous sinus invasion, there were often two or more simultaneous infiltration routes (60.6%); when only one route was involved, the foramen ovale was the most common (26.4%). In patients presenting with NPC, local disease spreads stepwise from proximal sites to more distal sites. Tumors extend quickly through privileged pathways such as neural foramina. The anatomic sites surrounding the nasopharynx are at low risk of concurrent bilateral tumor invasion. Selective radiotherapy of the local disease in NPC may be feasible.

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Author and article information

Journal

Journal ID (nlm-ta): Quant Imaging Med Surg

Journal ID (iso-abbrev): Quant Imaging Med Surg

Journal ID (publisher-id): QIMS

Title: Quantitative Imaging in Medicine and Surgery

Publisher: AME Publishing Company

ISSN (Print): 2223-4292

ISSN (Electronic): 2223-4306

Publication date (Electronic): 05 January 2023

Publication date (Print): 01 February 2023

Volume: 13

Issue: 2

Pages: 982-998

Affiliations

[1 ]deptSchool of Life & Environmental Science, Guangxi Colleges and Universities Key Laboratory of Biomedical Sensors and Intelligent Instruments , Guilin University of Electronic Technology , Guilin, China;

[2 ]deptCollaborative Innovation Center for Cancer Medicine , Sun Yat-sen University Cancer Center , Guangzhou, China

Author notes

Contributions: (I) Conception and design: H Chen, L Liu; (II) Administrative support: H Chen; (III) Provision of study materials or patients: H Li, L Liu; (IV) Collection and assembly of data: W Huang, G Ruan; (V) Data analysis and interpretation: H Li, S Yang, Q Gong, S Chen; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

[#]

These authors contributed equally to this work.

Correspondence to: Hongbo Chen. School of Life & Environmental Science, Guilin University of Electronic Technology, 1 Jinji Road, Guilin 541004, China. Email: hongbochen@ 123456163.com ; Lizhi Liu. Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 East Dongfeng Road, Guangzhou 510060, China. Email: liulizh@ 123456sysucc.org.cn .

[^]

ORCID: 0000-0002-0389-7875.

Article

Publisher ID: qims-13-02-982

DOI: 10.21037/qims-22-744

PMC ID: 9929427

SO-VID: 320eb9dd-0576-4faf-a338-55c1e9f6b405

License:

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

History

Date received : 16 July 2022

Date accepted : 08 December 2022

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Prognostic potential of a voxelwise invasion risk map of nasopharyngeal carcinoma based on a coordinate system of the nasopharynx

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Abstract

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Recursive Rule based Visual Categorization

Most cited references 62

Perineural Invasion and Perineural Tumor Spread in Head and Neck Cancer: A Critical Review

Locoregional extension patterns of nasopharyngeal carcinoma and suggestions for clinical target volume delineation

Extension of local disease in nasopharyngeal carcinoma detected by magnetic resonance imaging: improvement of clinical target volume delineation.

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