{"database":"biostudies-literature","file_versions":[],"scores":null,"additional":{"submitter":["Yan F"],"funding":["NCI NIH HHS"],"pagination":["536-549"],"full_dataset_link":["https://www.ebi.ac.uk/biostudies/studies/S-EPMC8380754"],"repository":["biostudies-literature"],"omics_type":["Unknown"],"volume":["165(4)"],"pubmed_abstract":["<h4>Objective</h4>Pathologic extranodal extension (ENE) is an important adverse feature for human papillomavirus (HPV)-negative head and neck squamous cell carcinoma (HNSCC), but the prognostic significance of microscopic ENE (ENE<sub>mi</sub>) and role of adjuvant concurrent chemoradiation (CRT) for ENE<sub>mi</sub> remain unclear. This study evaluates (1) the prognostic significance of ENE<sub>mi</sub> in HPV-negative HNSCC and (2) whether adjuvant CRT is associated with improved overall survival (OS) for these patients.<h4>Study design</h4>Retrospective cohort study.<h4>Setting</h4>Commission on Cancer (CoC)-accredited facilities.<h4>Methods</h4>This retrospective cohort study included patients in the National Cancer Database from 2009 to 2015 with pathologic node-positive (pN+) HPV-negative HNSCC with either pathologic ENE<sub>mi</sub> or no ENE who had undergone margin-negative surgery. The association of ENE<sub>mi</sub> with OS was evaluated using Cox proportional hazard analyses. Analyses were repeated in patients with ENE<sub>mi</sub> receiving adjuvant therapy to evaluate the association of adjuvant CRT with OS.<h4>Results</h4>We included 5483 patients with pN+ HPV-negative HNSCC, of whom 24% had ENE<sub>mi</sub>. On multivariable analysis, ENE<sub>mi</sub> was associated with decreased OS relative to no ENE (adjusted hazard ratio [aHR], 1.43; 95% CI, 1.28-1.59). Among patients with ENE<sub>mi</sub> who received ≥60 Gy of adjuvant radiation therapy (RT) (n = 617), adjuvant CRT was not associated with improved OS relative to RT (aHR, 0.91; 95% CI, 0.66-1.27).<h4>Conclusion</h4>For patients with HPV-negative HNSCC, pN+ with ENE<sub>mi</sub> is associated with worse OS than pN+ without ENE. However, for patients with ENE<sub>mi</sub>, concurrent CRT is not associated with improved OS relative to RT. The optimal adjuvant paradigm for ENE<sub>mi</sub> requires additional investigation."],"journal":["Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery"],"pubmed_title":["Microscopic Extranodal Extension in HPV-Negative Head and Neck Cancer and the Role of Adjuvant Chemoradiation."],"pmcid":["PMC8380754"],"funding_grant_id":["P30 CA138313"],"pubmed_authors":["Richardson MS","Li H","Graboyes EM","Day TA","Pipkorn P","Kaczmar JM","de Almeida JR","Sharma AK","Neskey DM","Yan F","Zenga J"],"additional_accession":[]},"is_claimable":false,"name":"Microscopic Extranodal Extension in HPV-Negative Head and Neck Cancer and the Role of Adjuvant Chemoradiation.","description":"<h4>Objective</h4>Pathologic extranodal extension (ENE) is an important adverse feature for human papillomavirus (HPV)-negative head and neck squamous cell carcinoma (HNSCC), but the prognostic significance of microscopic ENE (ENE<sub>mi</sub>) and role of adjuvant concurrent chemoradiation (CRT) for ENE<sub>mi</sub> remain unclear. This study evaluates (1) the prognostic significance of ENE<sub>mi</sub> in HPV-negative HNSCC and (2) whether adjuvant CRT is associated with improved overall survival (OS) for these patients.<h4>Study design</h4>Retrospective cohort study.<h4>Setting</h4>Commission on Cancer (CoC)-accredited facilities.<h4>Methods</h4>This retrospective cohort study included patients in the National Cancer Database from 2009 to 2015 with pathologic node-positive (pN+) HPV-negative HNSCC with either pathologic ENE<sub>mi</sub> or no ENE who had undergone margin-negative surgery. The association of ENE<sub>mi</sub> with OS was evaluated using Cox proportional hazard analyses. Analyses were repeated in patients with ENE<sub>mi</sub> receiving adjuvant therapy to evaluate the association of adjuvant CRT with OS.<h4>Results</h4>We included 5483 patients with pN+ HPV-negative HNSCC, of whom 24% had ENE<sub>mi</sub>. On multivariable analysis, ENE<sub>mi</sub> was associated with decreased OS relative to no ENE (adjusted hazard ratio [aHR], 1.43; 95% CI, 1.28-1.59). Among patients with ENE<sub>mi</sub> who received ≥60 Gy of adjuvant radiation therapy (RT) (n = 617), adjuvant CRT was not associated with improved OS relative to RT (aHR, 0.91; 95% CI, 0.66-1.27).<h4>Conclusion</h4>For patients with HPV-negative HNSCC, pN+ with ENE<sub>mi</sub> is associated with worse OS than pN+ without ENE. However, for patients with ENE<sub>mi</sub>, concurrent CRT is not associated with improved OS relative to RT. The optimal adjuvant paradigm for ENE<sub>mi</sub> requires additional investigation.","dates":{"release":"2021-01-01T00:00:00Z","publication":"2021 Oct","modification":"2025-04-04T12:04:29.073Z","creation":"2025-04-04T12:04:29.073Z"},"accession":"S-EPMC8380754","cross_references":{"pubmed":["33618570"],"doi":["10.1177/0194599821989637"]}}