Prognostic Value and the Potential Role of Treatment Options for Cervical Lymph Node Necrosis in Nasopharyngeal Carcinoma.

Objective: There were few studies focused on the cervical lymph necrosis (CNN) of nasopharyngeal carcinoma (NPC) patients to develop a nomogram and guide the treatment decision at the era of intensity modulated radiation therapy (IMRT). Material and Methods: The prognostic accuracy of CNN in the training cohort (n = 1940) was validated in Guangzhou internal validation cohort (n = 832) and two external validation cohorts (Dongguan, n = 232; Foshan, n = 134). Results: The primary end point was progression-free survival (PFS), calculated using the Kaplan-Meier method. After a median 60.0 months' follow-up, patients with CNN in the training cohort had worse 5-year PFS (70.8% vs. 89.1%, P < 0.001) than patients without CNN, which was validated in the validation cohorts. The nomogram based on CNN predicted an individual PFS risk (training: C-index 0.733; Guangzhou validation: C-index 0.736; Foshan: C-index 0.722; Dongguan: C-index 0.756). Stage N2 patients in the CNN group and stage IV patients no matter the status of CNN, PFS was better with induction chemotherapy (ICT) and CCRT than CCRT (P < 0.05). Conclusion: Taken together, CNN reliably predicts survival risk in NPC patients. N2 patients in the CNN group and stage IV patients may receive survival benefit from ICT.