建立并验证一种基于MRI检测到的颈后及颈部淋巴结特征和EB病毒DNA的预后刻度模型，以区分低风险患者，对他们来说仅放射治疗（IMRT）就足够了。本回顾性研究纳入了2010年8月至2019年5月期间拥有术前MRI检查的894例II期鼻咽癌（NPC）患者（分别在培训组和验证组中有596例和298例）。所有患者均接受了放射治疗（IMRT），部分患者还接受了化疗。我们使用单变量和多变量Cox回归分析鉴定了独立的风险因素。通过Kaplan-Meier曲线和log-rank检验比较患者的生存情况。多元分析得出的独立因素包括颈部淋巴结坏死（CNN）、颈部和颈后淋巴结的包膜外扩散（ECS）以及γ-谷氨酰转移酶（γ-GGT）。根据临床（肿瘤-淋巴结-转移（TNM）分期+EB病毒DNA）、临床-影像学（所有独立预测因子）和综合模型（临床-影像学模型+EB病毒DNA）建立了A、B和C三个刻度模型。刻度模型C（刻度指数0.769 [0.718-0.820]）比刻度模型B (0.762 [0.715-0.809])、刻度模型A (0.619 [0.564-0.674])和TNM分期 (0.560 [0.509-0.611])表现出更好的风险区分能力。在刻度模型C确定的低风险组中，接受放射治疗（RT）和其他方案（包括化疗）的患者生存差异不显著。将MRI检测到的颈后及颈部淋巴结特征与术前EB病毒DNA相结合的刻度模型改善了II期鼻咽癌的预后风险分层。© 2023 Elsevier Ltd.保留所有权利。

To develop and validate a prognostic nomogram based on MRI-detected features of retropharyngeal and cervical lymph nodes and Epstein-Barr virus (EBV) DNA in patients with stage II nasopharyngeal carcinoma (NPC) to distinguish low-risk patients for whom intensity-modulated radiotherapy (IMRT) alone is sufficient.This retrospective study enrolled 894 patients with stage II NPC (596 and 298 in the training and validation cohorts, respectively) with pretreatment MRI between August 2010 and May 2019. All patients received IMRT with or without additional chemotherapy. We identified independent risk factors using univariate and multivariate Cox regression analyses. Survival was compared using Kaplan-Meier curves with the log-rank test.Independent factors derived from the multivariate analysis include cervical nodal necrosis (CNN), the extracapsular spread (ECS) of cervical and retropharyngeal lymph nodes, and gamma-glutamyl transferase (γ-GGT). Nomograms A, B, and C were established based on the clinical [tumor-node-metastasis (TNM) stage + Epstein-Barr virus (EBV) DNA], the clinical-radiological [all independent predictors] and the combined models [the clinical-radiological model + EBV DNA], respectively. Nomogram C (C-index 0.769 [0.718-0.820]) demonstrated better risk discrimination than nomogram B (0.762 [0.715-0.809]), nomogram A (0.619 [0.564-0.674]), and the TNM stage (0.560 [0.509-0.611]). In the low-risk group divided by nomogram C, no significant survival differences were observed between patients treated with radiotherapy (RT) alone and other regimens including additional chemotherapy.The nomogram combining MRI-detected retropharyngeal and cervical lymph node features with pretreatment EBV-DNA improved the prognostic risk stratification for stage II NPC.Copyright © 2023 Elsevier Ltd. All rights reserved.