Prognostic Analysis of Patients With N1 Nasopharyngeal Carcinoma With Different Lymph Node Characteristics

Background Prognosis in patients with N1 nasopharyngeal carcinoma (NPC) remains heterogeneous, partly due to variations in lymph node involvement. This study evaluated the prognostic significance of different lymph node characteristics in N1 NPC. Methods We retrospectively analysed 160 newly diagnosed non‐metastatic N1 NPC patients treated at Liuzhou Worker's Hospital from January 2017 to May 2023. Kaplan–Meier curves were used to estimate survival outcomes, and Cox regression analysis was performed to identify independent prognostic factors. Results Among the 160 patients, 57 had retropharyngeal lymph nodes (RLNs) only, 24 had cervical lymph nodes (CLNs) only, and 79 had concurrent CLNs and RLNs involvement. The 5‐year overall survival (OS), progression‐free survival (PFS), locoregional relapse‐free survival (LRRFS), and distant metastasis‐free survival (DMFS) rates were 94.7%, 80.1%, 89.6%, and 88.8%, respectively. Patients with concurrent CLNs and RLNs involvement had worse OS than those with single‐region involvement (5‐year OS: 90.2% vs. 98.4%, p = 0.0238). Subgroup analysis showed that in T1‐2 patients, combined nodal involvement was associated with inferior OS, PFS, and LRRFS, whereas no significant survival differences were observed in T3‐4 patients. Multivariate analysis identified lymph node necrosis (LNN) as an independent adverse prognostic factor for LRRFS (HR = 4.056; 95% CI: 1.262–13.035; p = 0.019). Conclusion Lymph node characteristics further refine prognostic stratification in N1 NPC. Concurrent CLNs and RLNs involvement was associated with poorer survival, particularly in early T‐stage disease, while LNN was associated with an increased risk of locoregional recurrence.