Scholarlink

Purpose <p>Extranodal extension (ENE) is a major adverse factor in head and neck squamous cell carcinoma (HNSCC) and the basis for recommending adjuvant chemoradiotherapy (CRT). The independent prognostic role of ENE subtypes, however, remains unclear when other pathological features are considered.</p> Methods <p>We retrospectively studied 320 surgically treated patients with pathologically ENE-positive HNSCC (2018–2024). ENE was classified as microscopic (ENEmi, ≤ 2&#xa0;mm) or macroscopic (ENEma, &gt; 2&#xa0;mm) as per AJCC. Overall survival (OS) and disease-free survival (DFS) were primary endpoints. Multivariable Cox regression, propensity score matching (PSM), and receiver operating characteristic (ROC) analysis were performed.</p> Results <p>Of 320 patients, 194 (60.6%) had ENEmi and 126 (39.4%) ENEma. Three-year OS and DFS were 47% and 42%, respectively. ENEma was associated with worse unadjusted survival (3- year OS 36.6% vs. 53.9%, <i>p</i> = 0.01) and higher recurrence (66.7% vs. 52.1%), but differences lost significance after multivariable adjustment and PSM. Independent adverse factors included &gt; 3 positive nodes, T3–T4 stage, increasing depth of invasion, and large metastatic deposits. ROC confirmed &gt; 3 nodes as the optimal prognostic cutoff. Adjuvant CRT conferred marked benefit (OS HR 0.20; DFS HR 0.28; both <i>p</i> &lt; 0.001). Distant metastasis was the leading failure pattern (29.4%).</p> Conclusions <p>ENE subtype alone did not independently stratify prognosis once nodal burden was considered. Nodal count (&gt; 3) consistently outperformed ENE extent as a discriminator of survival. These findings highlight limitations of a dichotomous ENE classification and suggest that nodal burden thresholds may merit consideration in future staging frameworks, although the retrospective design necessitates prospective validation.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Redefining high-risk extranodal extension in head and neck cancer: beyond the minor–major dichotomy

  • 期刊论文

  • 发表日期：

    2026年3月17日

查看全文
  • Vimmi Gautam,
  • Mudit Agarwal,
  • Sunil Pasricha,
  • Abhishek Singh,
  • Shreya Rai,
  • Smriti Panda,
  • Gitanjali Deshpande,
  • Kshitiz Bansal,
  • Pradyumna Singh,
  • Rajat Saha,
  • Munish Gairola,
  • Manoj Gupta,
  • Jitin Goyal,
  • Meenakshi Kamboj,
  • Divya Bansal,
  • Rashmi Bansal

摘要

Purpose

Extranodal extension (ENE) is a major adverse factor in head and neck squamous cell carcinoma (HNSCC) and the basis for recommending adjuvant chemoradiotherapy (CRT). The independent prognostic role of ENE subtypes, however, remains unclear when other pathological features are considered.

Methods

We retrospectively studied 320 surgically treated patients with pathologically ENE-positive HNSCC (2018–2024). ENE was classified as microscopic (ENEmi, ≤ 2 mm) or macroscopic (ENEma, > 2 mm) as per AJCC. Overall survival (OS) and disease-free survival (DFS) were primary endpoints. Multivariable Cox regression, propensity score matching (PSM), and receiver operating characteristic (ROC) analysis were performed.

Results

Of 320 patients, 194 (60.6%) had ENEmi and 126 (39.4%) ENEma. Three-year OS and DFS were 47% and 42%, respectively. ENEma was associated with worse unadjusted survival (3- year OS 36.6% vs. 53.9%, p = 0.01) and higher recurrence (66.7% vs. 52.1%), but differences lost significance after multivariable adjustment and PSM. Independent adverse factors included > 3 positive nodes, T3–T4 stage, increasing depth of invasion, and large metastatic deposits. ROC confirmed > 3 nodes as the optimal prognostic cutoff. Adjuvant CRT conferred marked benefit (OS HR 0.20; DFS HR 0.28; both p < 0.001). Distant metastasis was the leading failure pattern (29.4%).

Conclusions

ENE subtype alone did not independently stratify prognosis once nodal burden was considered. Nodal count (> 3) consistently outperformed ENE extent as a discriminator of survival. These findings highlight limitations of a dichotomous ENE classification and suggest that nodal burden thresholds may merit consideration in future staging frameworks, although the retrospective design necessitates prospective validation.