{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T20:05:37Z","timestamp":1779393937598,"version":"3.53.1"},"reference-count":37,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,9,28]],"date-time":"2022-09-28T00:00:00Z","timestamp":1664323200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003785","name":"Guangdong Medical Research Foundation","doi-asserted-by":"publisher","award":["A2021423"],"award-info":[{"award-number":["A2021423"]}],"id":[{"id":"10.13039\/501100003785","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003785","name":"Guangdong Medical Research Foundation","doi-asserted-by":"publisher","award":["A2021075"],"award-info":[{"award-number":["A2021075"]}],"id":[{"id":"10.13039\/501100003785","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82171906"],"award-info":[{"award-number":["82171906"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Magnetic Resonance Imaging"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Metastatic lymph nodal number (LNN) is associated with the survival of nasopharyngeal carcinoma (NPC); however, counting multiple nodes is cumbersome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To explore LNN threshold and evaluate its use in risk stratification and induction chemotherapy (IC) indication.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Type<\/jats:title><jats:p>Retrospective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>A total of 792 radiotherapy\u2010treated NPC patients (N classification: N0 182, N1 438, N2 113, N3 59; training group: 396, validation group: 396; receiving IC: 390).<\/jats:p><\/jats:sec><jats:sec><jats:title>Field Strength\/Sequence<\/jats:title><jats:p>T1\u2010, T2\u2010 and postcontrast T1\u2010weighted fast spin echo MRI at 1.5 or 3.0\u2009T.<\/jats:p><\/jats:sec><jats:sec><jats:title>Assessment<\/jats:title><jats:p>Nomogram with (model B) or without (model A) LNN was constructed to evaluate the 5\u2010year overall (OS), distant metastasis\u2010free (DMFS), and progression\u2010free survival (PFS) for the group as a whole and N1 stage subgroup. High\u2010 and low\u2010risk groups were divided (above vs below LNN\u2010 or model B\u2010threshold); their response to IC was evaluated among advanced patients in stage III\/IV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Statistical Tests<\/jats:title><jats:p>Maximally selected rank, univariate and multivariable Cox analysis identified the optimal LNN threshold and other variables. Harrell's concordance index (C\u2010index) and 2\u2010fold cross\u2010validation evaluated discriminative ability of models. Matched\u2010pair analysis compared survival outcomes of adding IC or not. A <jats:italic>P<\/jats:italic> value\u2009&lt;\u20090.05 was considered statistically significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median follow\u2010up duration was 62.1\u2009months. LNN\u2009\u2265\u20094 was independently associated with decreased 5\u2010year DMFS, OS, and PFS in entire patients or N1 subgroup. Compared to model A, model B (adding LNN, LNN\u2009\u2265\u20094 vs &lt;4) presented superior C\u2010indexes in the training (0.755 vs 0.727) and validation groups (0.676 vs 0.642) for discriminating DMFS. High\u2010risk patients benefited from IC with improved post\u2010IC response and OS, but low\u2010risk patients did not (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.785 and 0.690, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>LNN\u2009\u2265\u20094 is an independent risk stratification factor of worse survival in entire or N1 staging NPC patients. LNN\u2009\u2265\u20094 or the associated nomogram has potential to identify high\u2010risk patients requiring IC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Evidence Level<\/jats:title><jats:p>4<\/jats:p><\/jats:sec><jats:sec><jats:title>Technical Efficacy<\/jats:title><jats:p>4<\/jats:p><\/jats:sec>","DOI":"10.1002\/jmri.28435","type":"journal-article","created":{"date-parts":[[2022,9,28]],"date-time":"2022-09-28T15:29:57Z","timestamp":1664378997000},"page":"1790-1802","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["<scp>MRI<\/scp>\u2010Based Metastatic Nodal Number and Associated Nomogram Improve Stratification of Nasopharyngeal Carcinoma Patients: Potential Indications for Individual Induction Chemotherapy"],"prefix":"10.1002","volume":"57","author":[{"given":"Qin","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Radiology Sun Yat\u2010sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy  Guangzhou Guangdong People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annan","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Radiology Sun Yat\u2010sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy  Guangzhou Guangdong People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9819-3549","authenticated-orcid":false,"given":"Chunyan","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Radiology Sun Yat\u2010sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy  Guangzhou Guangdong People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaowen","family":"Ou","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition The First Affiliated Hospital of Guangdong Pharmaceutical University  Guangzhou Guangdong People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangying","family":"Ruan","sequence":"additional","affiliation":[{"name":"Department of Radiology Sun Yat\u2010sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy  Guangzhou Guangdong People's Republic of 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