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Purpose <p>To evaluate the prognostic value of the Neck Imaging Reporting and Data Systems (NI-RADS) in early post-operative imaging for predicting recurrence and survival outcomes in high-risk oral cavity squamous cell carcinoma (SCC) patients undergoing post-operative radiotherapy (PORT).</p> Methods <p>This retrospective study included 84 patients with high-risk oral cavity SCC who were scheduled for PORT after radical surgery between January 2013 and May 2024. Early imaging with contrast-enhanced CT or MRI was performed within 12&#xa0;weeks post-surgery and scored using the NI-RADS system. Associations between NI-RADS scores, recurrence, and survival outcomes were analyzed using Kaplan–Meier and Cox proportional hazards models.</p> Results <p>Although NI-RADS was originally designed for post-treatment surveillance, we applied it to early post-operative imaging as an exploratory risk-stratification tool. NI-RADS scores significantly predicted regional disease-free survival (DFS) and overall survival (OS). Patients with higher NI-RADS <i>T</i> and <i>N</i> scores had poorer outcomes. Multivariable analysis confirmed early NI-RADS <i>T</i> as an independent predictor of OS (<i>p</i> = 0.01). Interobserver agreement for NI-RADS classifications was strong (Weighted Kappa: <i>T</i> = 0.837, <i>N</i> = 0.855). Although higher radiotherapy doses were administered to patients with NI-RADS 2–3 scores, these patients demonstrated worse outcomes, reflecting aggressive disease.</p> Conclusion <p>Early application of NI-RADS in post-operative imaging provides valuable prognostic insights, enabling risk stratification and tailored management in high-risk oral cavity SCC patients. Streamlining imaging workflows and exploring alternative therapeutic strategies for high-risk groups may further optimize outcomes.</p>

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Early post-operative NI-RADS predicts recurrence and survival in high-risk oral cavity squamous cell carcinoma undergoing adjuvant radiotherapy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月27日

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  • Mariangela Massaccesi,
  • Marco Panfili,
  • Rosalinda Calandrelli,
  • Silvia Longo,
  • Francesco Pastore,
  • Francesco Miccichè,
  • Calogero Casà,
  • Stefano Settimi,
  • Dario Antonio Mele,
  • Nicola Dinapoli,
  • Ciro Mazzarella,
  • Simona Gaudino,
  • Luca Tagliaferri,
  • Jacopo Galli,
  • Maria Antonietta Gambacorta,
  • Giovanni Almadori

摘要

Purpose

To evaluate the prognostic value of the Neck Imaging Reporting and Data Systems (NI-RADS) in early post-operative imaging for predicting recurrence and survival outcomes in high-risk oral cavity squamous cell carcinoma (SCC) patients undergoing post-operative radiotherapy (PORT).

Methods

This retrospective study included 84 patients with high-risk oral cavity SCC who were scheduled for PORT after radical surgery between January 2013 and May 2024. Early imaging with contrast-enhanced CT or MRI was performed within 12 weeks post-surgery and scored using the NI-RADS system. Associations between NI-RADS scores, recurrence, and survival outcomes were analyzed using Kaplan–Meier and Cox proportional hazards models.

Results

Although NI-RADS was originally designed for post-treatment surveillance, we applied it to early post-operative imaging as an exploratory risk-stratification tool. NI-RADS scores significantly predicted regional disease-free survival (DFS) and overall survival (OS). Patients with higher NI-RADS T and N scores had poorer outcomes. Multivariable analysis confirmed early NI-RADS T as an independent predictor of OS (p = 0.01). Interobserver agreement for NI-RADS classifications was strong (Weighted Kappa: T = 0.837, N = 0.855). Although higher radiotherapy doses were administered to patients with NI-RADS 2–3 scores, these patients demonstrated worse outcomes, reflecting aggressive disease.

Conclusion

Early application of NI-RADS in post-operative imaging provides valuable prognostic insights, enabling risk stratification and tailored management in high-risk oral cavity SCC patients. Streamlining imaging workflows and exploring alternative therapeutic strategies for high-risk groups may further optimize outcomes.