Numbers of MRI lymph nodes:robust prognosticator bridging radiology and risk quantification of distant metastasis in nasopharyngeal carcinoma

Motivation: Systematic comprise indicators of MRI-positive lymph nodes (MRI-LNs) Goal(s): Identify reliable prognostic factors to enhance risk stratification and clinical management of nasopharyngeal carcinoma (NPC) Approach: In this multicenter retrospective study (N=1,897), thirteen MRI-LNs features concerning number, size, and MRI characteristics were analyzed. Univariate and multivariate analyses identified confounding variables and established predictive model. Results: Among the 13 MRI-LNs features, only lymph node number (LNN) consistently demonstrated even distribution and independence across cohorts. Adjusting for LNN and necrosis number rendered other features insignificant for DMFS. LNN demonstrated significantly correlated with other MRI-LNs features and mediated their risk of distant metastasis. Impact: The multicenter validation reinforced the robust prognostic value of LNN in risk discrimination model, N staging optimization, and treatment implication. This study emphasizes LNN's predictive ability in clinical MRI interpretation and risk management.