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Multicenter Study
. 2020 Apr;130(4):939-945.
doi: 10.1002/lary.28059. Epub 2019 May 11.

Extranodal extension is a strong prognosticator in HPV-positive oropharyngeal squamous cell carcinoma

Eric Bauer  1 , Angela Mazul  1 , Rebecca Chernock  2 , Jason Rich  1 , Ryan S Jackson  1 , Randal Paniello  1 , Patrik Pipkorn  1 , Peter Oppelt  3 , Hiram Gay  4 , Mackenzie Daly  4 , Samir El-Mofty  2 , Wade Thorstad  4 , Douglas Adkins  3 , Jose Zevallos  1
Affiliations
Multicenter Study

Extranodal extension is a strong prognosticator in HPV-positive oropharyngeal squamous cell carcinoma

Eric Bauer et al. Laryngoscope. 2020 Apr.

Abstract

Objective: To comprehensively examine the prognostic significance of extranodal extension (ENE) in human papillomavirus-positive oropharyngeal squamous cell carcinoma (HPV-positive OPSCC).

Methods: Retrospective cohort of cases diagnosed with HPV-positive OPSCC from 2010 to 2015 in the National Cancer Database. Inclusion of all OPSCC HPV-positive cases with appropriate International Classification of Diseases-0-3 codes that received surgery with a neck dissection. Univariate and multivariable analyses were conducted. Hazard ratios (HR) for the independent effects of ENE and N stage on overall survival were estimated by Cox proportional hazards regression.

Results: Cases that were ENE-negative had the highest 5-year survival (92.6%; 95% confidence interval [CI]: 90.5%-94.7%). ENE-positive cases had the lowest 5-year survival (84.0%; 95% CI: 80.7%-87.4%). After adjusting for confounding variables, ENE-positivity was associated with almost twice the hazard of death (HR = 1.90; 95% CI: 1.35-2.67) compared to ENE-negative cases. Nodal (N) category 1, ENE-positive status was associated with an increased risk of death (HR = 1.88; 95% CI: 1.26-2.80) compared with N1, ENE-negative status. Compared to N1/ENE-negative cases, N2/ENE-positive cases had the poorest survival (HR: 2.93; 95% CI: 1.94-4.43). Both microscopic and macroscopic ENE were associated with worse outcomes compared to node-positive/ENE-negative status.

Conclusion: The implementation of the American Joint Committee on Cancer 8th edition staging system provides a much-improved framework to develop and discuss treatment plans for HPV-positive OPSCC. We feel that careful consideration should be given to the importance of ENE in patients with HPV-positive OPSCC.

Level of evidence: 4 Laryngoscope, 130:939-945, 2020.

Keywords: AJCC staging; HPV-positive; extranodal extension; head and neck; neck; neck dissection; oropharyngeal squamous cell carcinoma; oropharynx.

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References

BIBLIOGRAPHY

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