Thèses sur le sujet « Nodal metastase »

Canine oncology has recently reported interest in the detection of occult nodal metastases, and efforts have been made to identify the best strategy for accurate nodal staging. In this scenario, the present PhD thesis was aimed to improve knowledge on the current understanding of the feasibility and impact of sentinel lymph node (SLN) mapping with radiopharmaceutical and blue dye in cancer-bearing dogs. Initially, we evaluated the technique in canine mast cell tumors (MCT), given the high prevalence of this tumor type, the propensity for lymphatic spread and recognized prognostic impact of nodal metastases. Thirty client-owned dogs with 34 MCT were included. At least one SLN was identified in all but 3 dogs that had a scar from previously excised MCT, and in 30 cases (63%) the SLN did not correspond to the regional lymph node (RLN). As a second step, we explored the impact of SLN mapping and extirpation in dogs with head and neck tumors, given the well-accepted unpredictability of patterns of nodal metastases. Twenty-three dogs with tumors of the head and neck and absence of clinically evident nodal disease (cN0 neck) were prospectively included and underwent tumor excision and SLN extirpation. Reported detection rate was 83%, with at least one SLN identified in all but 4 dogs with thyroid tumors. In 52% of dogs, the SLN did not correspond to the RLN and at histopathology 42% of dogs had nodal metastases, of which 4 differed from the RLN. As the last step of this PhD project, we conducted an explorative study to identify clinical or pathological characteristics that could allow for identification of dogs with MCT at lower risk of SLN metastases, that could be excluded a priori from the SLN mapping and extirpation. Surprisingly, tumor grade was not able to predict the risk of having HN2-3 or HN3 SLN and the only variables that correlated with nodal metastases were tumor size, number or SLN and subcutaneous MCT. Given low to moderate discriminant ability, however, none of these variables could safely determine the exclusion of patients from the procedure. Results of the present project underscore the utility of implementation of SLN biopsy in the management of dogs with MCT and head and neck tumors, given the low correspondence between clinically expected RLN and SLN and the high rate of occult nodal metastases that could be detected with this procedure. Future research should be aimed at investigating the impact on long-term prognosis and disease free interval of the extirpation of metastatic SLN, and identify variables that could allow for exclusion of low-risk patients from the procedure.

Includes bibliography.
The aim of this study was to develop a practical and reproducible multi-marker RT-PCR essay, with the emphasis on achieving maximum specificity for the detection of melanoma nodal metastases. A novel protocol for the efficient homogenisation of nodal tissue was developed, with clinical applicability as the objective.

Around 20% of patients, diagnosed with a clinically localized primary cutaneous melanoma, have occult lymph node metastases. Lymphatic mapping and sentinel node biopsy, using pre-operative lymphoscintigraphy, intra-operative blue dye injection and gamma probe localization, in most cases identifies the node or nodes most likely to contain occult metastases, if present. The presence or absence of such metastases is the most powerful prognostic indicator in this group of patients. However, a number of other factors related to the patient and the primary melanoma can be used to determine prognosis. It is therefore important that the quality of lymphatic mapping is maximized and information gained from sentinel node biopsy is used to best effect, so that advice and treatment can be tailored to the individual patient. The studies contained within this thesis represent an attempt to improve the quality and individualization of care. The technique of lymphatic mapping using lymphoscintigraphy has been critically analysed to identify sources of inaccuracy. The frequency and causes of failure to identify sentinel nodes using lymphoscintigraphy have been determined in a large series of patients. The lymphatic drainage patterns from the head and neck have been investigated, using the forehead and its subdivisions, in order to produce new recommendations for selective neck dissection. The relative importance of clinical and pathological factors in sentinel node positive patients and the significance of nodal metastasis beyond sentinel nodes have been determined. A new prognostic classification or survival tree has been developed for patients with occult nodal metastases and then validated in a separate population. This allows four distinct prognostic groups with 5-year survival ranging from over 90% to around 20% to be identified. The prognostic groups differentiate patients who are at high and low risk of having occult distant metastases and so could be used to select patients for entry into clinical trials of adjuvant therapies as well as to determine who should receive existing adjuvant therapies. The survival tree has been compared with currently available prognostic tools with favourable results.

Introduction: Malignant Melanoma is the most lethal of the skin cancers and the UK incidence is rising faster than that of any other cancer. Breslow thickness remains the best predictor of metastasis and Sentinel Lymph Node Biopsy is the only method of detecting nodal spread in clinically node negative patients. Surgery is the only effective therapy. Angiogenesis – the growth of new vessels from pre-existing vasculature - is an absolute requirement for tumour survival and progression beyond a few hundred microns in diameter. Anti- angiogenic isoforms of VEGF have been demonstrated previously to be protective with regard to metastasis. The aims of this thesis were to determine whether VEGF expression within the tumour may allow prediction of the nodal status. Furthermore another aim was to determine whether via the “Seed and Soil” theory, by examination of angiogenic and lymphangiogenic profiles of the tumour and node can we determine that the tumour may control the microenvironment around the Sentinel Node? Finally, as a cohort of false negative patients emerged with a higher mortality rate than their true negative and true positive patient cohort counterparts, could any further patterns be established by performing the same experiments on these patients? Methods: Archived human tumour and corresponding Sentinel Node samples were used and immunohistochemistry was used to investigate the role of pro and anti angiogenic isoforms of VEGF, VEGF-C, LYVE-1 and CD31 within these patients. Results: VEGF-C expression was significantly increased in the intranodal component of positive Sentinel Lymph Nodes (p < 0.01 Bonferroni). This increased expression appeared to be independent of tumoural influences and no strong evidence for the “Seed and Soil” theory was proved. A significantly higher number of lymphatic vessel counts were identified within node negative patients (p < 0.05 ANOVA). No further significant findings were defined on examination of the false negative cohort of patients. Conclusions: This study has shown that positive Sentinel Lymph Nodes exhibit high levels of intranodal VEGF-C. This expression does not appear to be related to tumoural influences. It would therefore appear that VEGF-C expression within Sentinel Nodes warrants further investigation and may aid diagnosis of spread or represent a target to slow or even prevent the onset of metastasis.

BACKGROUND The number of patients with colorectal cancers (CRCs) invading the submucosa (pT1) resected during colonoscopy is increasing due to the screening. Such tumors are potentially metastatic, but only 15% of patients have nodal involvement. Histologic criteria currently used for selecting patients needing resection are imprecise and most patients are overtreated. Tumor infiltrating lymphocytes (TILs) and mismatch repair (MMR) status impact on CRC prognosis and could be risk factors of nodal metastasis. AIM To identify patients requiring completion surgery, the value of histologic variables, TILs, and MMR status as risk factors of nodal metastasis was investigated in screening detected and endoscopically removed pT1 CRCs. MATERIALS AND METHODS Histologic variables, CD3+ and CD8+ TILs, and MMR status were assessed in 102 endoscopically removed pT1 CRC. Univariate and multivariate analyses were used to evaluate the correlation with nodal metastasis. RESULTS Positive resection margin, evidence of vascular invasion and tumor budding, wide area of submucosal invasion, and high number of CD3+ TILs were associated with nodal metastasis in univariate analyses. Vascular invasion was statistically independent in multivariate analysis. Evidence of neoplastic cells in the vessels and/or at the excision border featured 5 out of 5 metastatic tumors and 13 out of 97 non-metastatic ones. CONCUSIONS Completion surgery should be mandatory only for patients with pT1 CRC with vascular invasion or with tumor cells reaching the margin. In all other cases, the treatment choice should be entrusted to the evaluation of the risk-benefit ratio of each patient considering the rarity of nodal metastasis.
INTRODUZIONE Il numero di pazienti con cancro colo-rettale (CCR) infiltrante la sottomucosa (pT1) rimosso durante colonscopia è in aumento per via dello screening. Tale tumore potenzialmente è già metastatico, ma solo un 15% di pazienti ha coinvolgimento linfonodale. I criteri istologi attualmente utilizzati per selezionare i pazienti che necessitino di una resezione di completamento sono imprecisi e la maggior parte dei pazienti subisce un trattamento eccessivo. I linfociti intra-tumorali (TILs) e lo stato del mismatch repair (MMR) condizionano la prognosi del CRC e potrebbero essere fattori di rischio di metastasi linfonodale. OBIETTIVO Per identificare i pazienti che necessitano di chirurgia di completamento, è stato valutato nei CRC pT1 identificati dallo screening e rimossi endoscopicamente il valore delle variabili istologiche, dei TILS e dello stato del MMR come fattori di rischio di metastasi linfonodale. MATERIALI E METODI Le variabili istologiche, i TILS CD3+ e CD8+ e lo stato del MMR sono stati valutati in 102 CRC pT1 rimossi endoscopicamente. Analisi univariate e multivariate sono state utilizzate per valutare la correlazione con la metastasi lindonodale. RISULTATI Il margine di resezione positive, la presenza di invasione vascolare e di budding tumorale, l'ampia area di invasione e l'elevato numero di TILs CD3+ erano associata alla metastasi linfonodale nelle analisi univariate. L'invasione vascolare era l'unica variabili indipendente all'analisi multivariata. La presenza di cellule neoplastiche intravascolari e/o a livello del margine di resezione caratterizzavano tutti e 5 i tumori metastatici e solo 13 tumori non metastatici su 97. CONCUSIONI La chirurgia di completamento dovrebbe essere indicata solo per i pazienti con un CRC pT1 con invasione vascolare o con cellule neoplastiche che raggiungono il margine di resezione. In tutti gli altri casi, la scelta del trattamento dovrebbe essere affidata alla valutazione del rapporto rischi-benefici di ciascun paziente tenendo in considerazione la rarità del coinvolgimento linfonodale.

Radical prostatectomy (RP) is a treatment option for men with localized prostate cancer. Extended pelvic lymph node dissection (ePLND) at the time of RP is recommended only in patients at risk of lymph node invasion (LNI), where a more accurate disease staging can tailor further adjuvant treatments. The risk of LNI is assessed through preoperative models, such as the Briganti nomograms, which are based on clinical features. They allow for sparing ePLND in a significant proportion of patients, but their accuracy is still suboptimal. Unfortunately, ePLND is associated with significant risks of complications. Therefore, improving our ability to detect LNI in prostate cancer would be key to avoid ePLND-related morbidity. Multiparametric MRI (mp-MRI) proved to be the most accurate imaging technique for local staging prior to RP, improving also the ability to predict LNI. For this reason, mp-MRI tumor features have been included in the latest version of the Briganti nomogram. Beside this, epigenetic expression of prostate cancer cells showed to be highly informative of the biological behavior of prostate cancer, even in terms of lymph node dissemination. Thus, exploring epigenetic patterns within biopsy tumor samples may further improve the prediction of LNI. Based on these premises, we aimed at developing a novel predicting model that included clinical, radiological, and epigenomic data. To accomplish this aim, we recruited 172 patients with localized prostate cancer diagnosed via combined target and systematic prostate biopsy and undergoing radical prostatectomy and ePLND. Epigenetic profiles of tumor DNA from target and systematic cores were sequenced via reduce representation bisulfite conversion. Gene pathways involved in gene transcription and regulation were significantly associated with LNI. Similarly, gene pathways involved in the transcription of potassium channels were associated with LNI, but only when target samples were considered. We identified 508 and 511 highly differentially methylated CpGs sites within target and systematic samples respectively, that were associated with LNI. The resulting epigenetic signatures were then integrated with conventional risk-factors, such as PSA at biopsy, T-stage at mp-MRI, and ISUP Gleason grade group at target biopsy, to develop two LNI predicting models. After train-test validations, we achieved an AUC of 86.0% for the target model and 82.7% for the systematic model. Both models outperformed Briganti nomograms for LNI prediction at internal validation.
La prostatectomia radicale (RP) è un'opzione di trattamento negli gli uomini con carcinoma prostatico localizzato. In questi pazienti si consiglia di eseguire la linfoadenectomia pelvica (ePLND), ma solo se il rischio di invasione linfonodale (LNI) è rilevante. Infatti, una più accurata stadiazione della malattia può facilitare l’indicazione ad ulteriori trattamenti adiuvanti. Il rischio di LNI è valutato attraverso l’uso di modelli predittivi, come i nomogrammi Briganti. L’utilizzo di questi modelli predittivi permette di evitare la ePLND in una percentuale significativa di pazienti. Tuttavia, la loro accuratezza non è del 100%. Sfortunatamente, ePLND si associata ad un rischio significativo di complicanze. Pertanto, migliorare la nostra capacità di predire l'LNI permetterebbe di evitare ePLND quando non necessaria. In tal senso, la risonanza magnetica multiparametrica (mp-MRI) si è rivelata la tecnica di imaging più accurata per la stadiazione locale del tumore prostatico, migliorando anche la capacità di predire LNI. Per questo, le caratteristiche del tumore alla mp-MRI sono state incluse nell'ultima versione del nomogramma Briganti. Recenti ricerche traslazionali hanno evidenziato come l’espressione epigenetica delle cellule del cancro alla prostata possa fornire importanti informazioni sul comportamento biologico del tumore, e anche sul suo rischio di diffusione linfonodale. Perciò, l’analisi dei pathways epigenetici espressi dal tumore prostatico potrebbe migliorare ulteriormente la capacità di predire LNI. Sulla base di queste premesse, abbiamo avviato uno studio volto a sviluppare un nuovo modello predittivo che includesse dati clinici, radiologici ed epigenomici per migliorare la predizione di LNI in pazienti con tumore prostatico e candidati ad RP. Per raggiungere questo obiettivo, abbiamo reclutato 172 pazienti con tumore alla prostata localizzato ed identificato tramite una biopsia target e sistematica, successivamente sottoposti a RP ed ePLND. Abbiamo processato i campioni bioptici, positivi per coinvolgimento tumorale, derivati dal campionamento target e sistematico, analizzando i pathways epigenetici associati a LNI. Il DNA tumorale derivante dai frustoli bioptici target e sistematici è stato sequenziato tramite conversione del bisolfito. Da queste analisi abbiamo osservato che alcuni pathways epigenetici coinvolti nella trascrizione e nella regolazione genica erano significativamente associati a LNI sia nei campioni target che sistematici. Allo stesso modo, altri pathways epigegetici coinvolti nella trascrizione dei canali del potassio erano associati a LNI, ma solo quando venivalo analizzati i campioni target. Abbiamo identificato 508 e 511 siti di CpG, rispettivamennte da campioni target e sistematici, che erano differenzialmente metilati nei pazienti con e senza LNI. Questi siti CpG sono stati utilizzati per creare due score epigenetici, i quali a loro volta sono stati integrati con fattori di rischio convenzionali, come il PSA alla biopsia, lo stadio T alla mp-MRI, e il Gleason score alla biopsia target, per sviluppare due modelli predittivi di LNI. Dopo validazione interna, i modelli hanno raggiunto una AUC dell'86,0% per il modello target e dell’82,7% per il modello sistematico. Entrambi i modelli sono risultati più accurati dei nomogrammi di Briganti in validazione interna. In conclusione, questo studio ha permesso di definire nuovi pathways epigenetici da campioni bioptici di tumore prostatico, ad oggi sconosciuti. Sono stati inoltre sviluppati due nuovi modelli predittivi per LNI, che integrano caratteristiche cliniche, della mp-MRI ed epigenetiche e che per altro si sono mostrati superiori in accuratezza ai nomogrammi attualmente disponibili, in attesa di ulteriori validazioni.

Chemokines are responsible for the directed migration of leukocyte chemotactic cytokines, coordinating cell movement during inflammation and the transport of hematopoietic cells. In addition to leukocytes, chemokine receptors are also found in neoplastic cells and tumors associated with stromal cells. Among chemokines, and the CXCR4/CXCL12 CCR7/CCL21 systems have been shown the involvement of lymph node metastases or distant metastases in different cancers. Thus, aim of this study was to evaluate the expression of CXCR4, CXCL12, CCR7, CCL21 and Ki-67 in oral squamous cell carcinoma (SCC) and to correlate these markers with clinicopathological indicators, lymph node metastasis and survival. We conducted a survey of reports and paraffin blocks of excisional biopsies of patients with SCC treated at the Hospital Haroldo JuaÃaba (2001-2009). Data on anatomic location of the lesion, sex, age, patient survival, degree of histological differentiation of the tumor, tumor stage and presence or absence of lymph node metastasis, lymphovascular and perineural invasion, nuclear grade and depth of invasion were collected. For immunohistochemical analysis, followed by the technique of streptavidin-biotin-peroxidase using the anti-CXCR4, anti-CXCL12, anti-CCR7, anti-CCL21 and Ki-67 antibody. Histological sections were photomicrographed in 10 fields chosen randomly and measured for the number of labeled tumor cells and determined the percentage of each labeling antibody. The marking of CXCR4 was detected in the cytoplasm and nucleus, CXCL12, CCR7 and CCL21 were only cytoplasmic, their expression was observed in 18 (60%) 8 (22.66%) 16 (53.3%) and 3 (12%) cases, respectively. We found a significant positive association between lymphovascular invasion and immunostaining of CXCR4 (p = 0.007) and CCR7 (P = 0.01) and among these cases metastasis was present in 62.5% and 37.5%, respectively. When in combination with Ki67, we found a significant positive correlation between CXCR4 (p = 0.0086), CXCL12 (p = 0.036) and CCR7 (p = 0:04). Among patients CXCR4 + over 111 months, only 38.4% were alive (p = 0.845), whereas both patients CCR7 + (p = 0.398) as well as CXCR4 +, and CCR7 + (p = 0.441) after 62 months, everyone had already died. We conclude that these chemokines are associated with lymphovascular invasion and cell proliferation, perhaps favoring the development of metastasis and poor prognosis.
As quimiocinas sÃo citocinas quimiotÃticas responsÃveis pela migraÃÃo direcionada de leucÃcitos, coordenando o movimento celular durante a inflamaÃÃo e o transporte de cÃlulas hematopoiÃticas. AlÃm dos leucÃcitos, os receptores de quimiocinas tambÃm sÃo encontrados em cÃlulas neoplÃsicas e em tumores associados com cÃlulas estromais. Dentre as quimiocinas, os sistemas CXCR4/CXCL12 e CCR7/CCL21 tÃm sido demonstrado no envolvimento de metÃstases linfonodais ou à distÃncia em diferentes tipos de cÃncer. Dessa forma, foi objetivo desse trabalho avaliar a expressÃo de CXCR4, CXCL12, CCR7, CCL21 e Ki-67 em carcinoma de cÃlulas escamosas orais (CEC) e correlacionar estes marcadores com indicadores clÃnicopatolÃgicos, metÃstase linfonodal e sobrevida. Realizou-se um levantamento de laudos e blocos parafinados de biopsias excisionais de pacientes portadores de CEC tratados no Hospital Haroldo JuaÃaba (2001 a 2009). Foram coletados dados sobre localizaÃÃo anatÃmica da lesÃo, sexo, idade, sobrevida do paciente, grau de diferenciaÃÃo histopatolÃgica do tumor, estadiamento tumoral e presenÃa ou ausÃncia de metÃstase linfonodal, invasÃo linfovascular e perineural, grau nuclear e profundidade de invasÃo. Para reaÃÃo de imunohistoquÃmica, seguiu-se a tÃcnica da estreptavidina-biotina-peroxidase, utilizando os anticorpos anti-CXCR4, anti-CXCL12, anti-CCR7, anti-CCL21 e Ki-67. As secÃÃes histolÃgicas foram fotomicrografadas em 10 campos escolhidos aleatoriamente e quantificadas quanto ao nÃmero de cÃlulas tumorais marcadas e determinado o percentual de marcaÃÃo de cada anticorpo. A marcaÃÃo de CXCR4 foi detectada em citoplasma e nÃcleo, CXCL12, CCR7 e CCL21 tiveram marcaÃÃo apenas citoplasmÃtica, sendo observada suas expressÃes em 18 (60%), 8 (22,66%), 16 (53,3%) e 3 (12%) casos, respectivamente. Encontrou-se uma associaÃÃo significativa positiva entre a invasÃo linfovascular e a imunomarcaÃÃo do CXCR4 (p=0.007) e CCR7 (p=0.01) e dentre esses casos a metÃstase esteve presente em 62,5% e 37,5%, respectivamente. Quando em associaÃÃo com o Ki67, encontrou-se uma correlaÃÃo positiva significante entre o CXCR4 (p=0.0086), CXCL12 (p=0.036) e CCR7 (p=0.04). Dentre os pacientes CXCR4+, ao longo de 111 meses, apenas 38,4% estavam vivos (p=0.845), ao passo que tanto para pacientes CCR7+ (p = 0.398), quanto CXCR4+ e CCR7+ (p = 0.441), apÃs 62 meses, todos haviam ido a Ãbito. Conclui-se que essas quimiocinas estÃo associadas com a invasÃo linfovascular e proliferaÃÃo celular, talvez favorecendo o desenvolvimento de metÃstases e um pior prognÃstico.

Bone is a common site for metastases and spine represent the most frequent site. Lytic lesions are associated with the loss of bone tissue, which can compromise the mechanical competence of the vertebra, leading to spine instability. Rigid stabilization is a solution, but it is a complex surgery, that can be very critical for oncologic patients; on the other hand, an untreated metastasis can lead to mechanical failure of the bone, leading to pain, immobilization and in the worst case, paralysis. In this study, a protocol to analyse the strain with simulated lytic metastasis under compressive loading has been developed and optimized using a porcine vertebra. The strain distribution has been measured experimentally using micro-computed tomography (micro-CT) and Digital Volume Correlation (DVC), which provided three-dimensional displacements and strains maps inside the specimen. The ideal parameters for the DVC have been found by analysing two repeated scans in constant strain condition and setting a target of 200 microstrain for the errors (one order of magnitude lower than typical strains in bone subjected to physiological loading conditions). An ideal nodal spacing of 50 voxels (approximately 2 mm) has been chosen and a voxel detection algorithm has been applied to all data to remove regions outside the bone. In order to understand how the presence of the defect could alter the strain distribution, the porcine vertebra has also been subjected to non-destructive compressive load before and after the preparation of a mechanically induced lytic metastasis in the vertebral body. An increase of the 40% of the compressive principal strain after the defect has been found in proximity of the lesion. This protocol will be used in future studies to analyse the effect of size and position of artificially metastatic lesions in the vertebral body of human spines.

博士
國立清華大學
生醫工程與環境科學系
104
The detection of cervical nodal metastases is important for the prognosis and treatment of head and neck tumors. The purposes of present study were first to assess the ability of apparent diffusion coefficient (ADC) values at 3.0T to distinguish malignant from benign lymph nodes and second to analyze ADC from partitions through a fuzzy C-means (FCM) technique for distinguishing nodal metastasis in head and neck cancer. From July 2009 to June 2010, 22 patients (21 males and 1 female; mean age, 49.8 ± 9.5 years; age range, 28–66 years) scheduled for surgical treatment of biopsy-proven head and neck cancer were prospectively and consecutively enrolled in this study. All patients were scanned on a 3.0T imaging unit (Verio; Siemens, Germany) using a 12-channel head coil combined with a 4-channel neck coil. All lymph nodes seen on DWI images were proceeded ADC calculation from ADC maps. All lymph nodes also were analyzed using in-house software developed using MATLAB. A radiologist manually contoured the lesions, and ADC values for each lesion were divided into 2 (low and high) and 3 (low, intermediate, and high) partitions by using the FCM clustering algorithm. Histologic findings were the reference standard for the diagnosis of lymph nodes metastasis. The ADC values derived from the signal intensity averaged across images obtained with b values of 0 and 800 s/mm2 was 1.086 ± 0.222 × 10-3 mm2/s for benign lymph nodes and 0.705 ± 0.118 × 10-3 mm2/s for malignant lymph nodes (P < .0001). When an ADC value of 0.851 × 10-3 mm2/s was used as a threshold value for differentiating benign from malignant lymph nodes, the best results were obtained with an accuracy of 91.0%, sensitivity of 91.3%, and specificity of 91.1%. From FCM technique, the results showed that the low value ADC clusters were more sensitive (95.7%) in distinguishing malignant from benign lesions than the whole-lesion mean ADC values (78.3%), while retaining a high specificity (approximately 90%). Moreover, receiver operating characteristic curves demonstrated that the low value ADC clusters used as a predictor of malignancy for lymph nodes could achieve a higher area under the curve (0.949 and 0.944 for 2 and 3 partitions, respectively). In conclusion, ADC value is a sensitive and specific parameter that can help to differentiate malignant from benign lymph nodes. But, the ADC cutoff value to distinguish malignant lymph nodes was that metastatic nodes with necrotic areas might have higher ADC values because of necrosis and might be misidentified as benign. the FCM clustering technique as a computed aid to prevent this bias.

碩士
長庚大學
臨床醫學研究所
106
Objectives: In patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with concurrent chemoradiotherapy (CCRT), we investigated the relationships between (1) metastatic neck lymph nodes necrotic and cystic changes on pre-treatment CT or MR images, and (2) post-treatment tumor recurrence and survival status. Methods: We retrospectively reviewed pretreatment CT and MRI and clinical courses of patients with OPSCC completed chemoradiotherapy in our institute from 2005 to 2015. Cervical necrotic and cystic nodal metastasis were classified on CT and MRI images. Propensity score matching was used to balance clinical and histopathologic factors between patients with pre-treatment CT and MR images. And their association with post-CCRT recurrence and long-term survival status analyzed before and after propensity score matching. Results: Of 224 patients eligible for analysis, 91 patients had pre-treatment CT images, and 80 patients had MR images. Another 53 patients had both CT and MR images. Diagnostic performance of MRI for detecting nodal necrotic and cystic change (sensitivity: 96.55% and 100.00%) is better than that of CT (sensitivity: 72.41% and 71.43%). Both nodal necrotic change and cystic changes on MRI are significant correlation with post-CCRT regional nodal recurrence, distant metastases, disease-fee survival and overall survival. Either nodal necrotic change on CT or cystic change on CT are not significant predictor for recurrence and survival status. After propensity score matching, nodal necrotic change is correlated with regional nodal recurrence (RR = 2.972, p = 0.009), distant metastasis (RR = 1.960, p = 0.050), disease-free survival (HR = 2.173, p = 0.007) and overall survival (HR = 2.877, p = 0.001) based on the image findings pooled from both CT and/or MR image findings. Cystic change is protective factor for regional nodal recurrent (RR = 0.411, p = 0.058), distant metastasis (RR = 0.405, p = 0.052), and disease-free survival (only in univariate COX regression analysis, HR=0.448, p = 0.034). Conclusions: Neck nodal necrotic and cystic changes on MRI are significant predictors for post-CCRT tumor recurrence and survival. The same effects are also found based on the pooled data from CT and/or MR images after propensity score matching. However, analysis based on CT image findings alone cannot find similar predicting effect, which can be explained by the inferior sensitive and accuracy of CT for detecting nodal necrotic and cystic changes. Therefore, we recommend that OPSCC patients should have MR for their pre-treatment evaluation.