Evaluation of the level of progression of extracapsular spread for cervical lymph node metastasis in oral squamous cell carcinoma

Yamada, Shin‐ichi; Yanamoto, Souichi; Otani, Shohei; Hasegawa, Takumi; Miyakoshi, Masaaki; Minamikawa, Tsutomu; Ohga, Noritaka; Kamata, Toshihide; Komori, Takahide; Kitagawa, Yoshimasa; Kitamura, Hiroshi; Umeda, Masahiro

doi:10.1016/j.ijom.2015.09.005

Cited by 18 publications

(2 citation statements)

References 26 publications

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“…This system of microscopic and macroscopic categorization has been described as being subjective and imprecise with the definition being vague [25]. Early studies on the descriptive of capsule/soft tissues interface for pENE [31,46] were initially considered ambitious but failed to show significance in multivariate analysis [43,47]. Direct measurement of pENE in millimeters is a more precise method for quantifying extent of soft tissues invasion.…”

Section: Pathological Staging Of Extranodal Extensionmentioning

confidence: 99%

Extranodal extension in head and neck squamous cell carcinoma: need for accurate pretherapeutic staging to select optimum treatment and minimize toxicity

Bradley

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review In 2017, the American Joint Committee on Cancer (AJCC) introduced the inclusion of extracapsular nodal extension (ENE) into the N staging of nonviral head and neck squamous cell carcinoma (HNSCC), while retaining the traditional N classification based on the number and sizes of metastatic nodes. The extent of ENE was further defined as microscopic ENE (ENEmi) and major ENE (ENEma) based on extent of disease beyond the nodal capsule (≤ or > 2 mm). This article reviews the evidence and progress made since these changes were introduced. Recent findings The ‘gold standard’ for evaluation ENE is histopathologic examination, the current preferred primary treatment of patients with HNSCC is by radiation-based therapy ± chemotherapy or biotherapy. The current pretreatment staging is by imaging, which needs improved reliability of radiologic rENE assessment with reporting needs to consider both sensitivity and specificity (currently computed tomography images have high-specificity but low-sensitivity). Adjuvant chemotherapy is indicated for patients with ENEma to enhance disease control, whereas for patients with ENEmi, there is a need to assess the benefit of adjuvant chemotherapy. Evidence that the presence of pENE in HPV-positive oropharyngeal carcinoma is an independent prognostic factor and should be considered for inclusion in future AJCC editions has recently emerged. Summary There remains a paucity of data on the reliability of imaging in the staging of rENE, more so the for the accurate assessment of ENEmi. Optimistic early results from use of artificial intelligence/deep learning demonstrate progress and may pave the way for better capabilities in tumor staging, treatment outcome prediction, resulting in improved survival outcomes.

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Section: Pathological Staging Of Extranodal Extensionmentioning

confidence: 99%

Extranodal extension in head and neck squamous cell carcinoma: need for accurate pretherapeutic staging to select optimum treatment and minimize toxicity

Bradley

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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“…ECS has been identified in numerous studies, for example, the analysis by Michikawa and colleagues, as one of the most important predictors of a poor treatment outcome [ 21 ]. ECS is one important factor in the decision to intensify adjuvant therapy, as the prognosis of ECS in OSCC patients is associated with the level of progression of ECS [ 22 ]. ECS accounts for significantly reduced OS and DFS, and the presence of ECS in patients with OSCC generally indicates a poor overall prognosis [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of lymph node involvement in oral squamous cell carcinoma

et al. 2022

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Objectives Different parameters have been identified in patients with oral squamous cell carcinomas (OSCC) that have a serious impact on survival, including residual tumour and extracapsular spread. Moreover, other factors, including the lymph node ratio (LNR) and lymph node yield (LNY), have been suggested as prognostic markers. Material and methods This retrospective study included patients diagnosed with OSCC and cervical lymph node metastases during the years 2010–2020. Patients’ records were evaluated regarding lymph node status, final therapy regime, tumour recurrence, time to death, tumour association with death, disease-free survival (DSF), and overall survival (OS). Results In 242 patients with a mean age of 63.57 ± 11.24 years, treated either by selective neck dissection (SND; n = 70) or by modified radical neck dissection (MRND; n = 172), 5772 lymph nodes were detected. The LNR and LNY were identified as independent risk factors in OS and DFS. The optimal cut-off point for the LNY was ≥ 17 lymph nodes in the SND and ≥ 27 lymph nodes in the MRND group. The metastatic lymph node clearance (MLNC) was established as a score to relate the LNR and LNY to the extent of lymph node removal. Survival analysis showed statistically significant differences among score levels. Conclusions As information about the extent of nodal dissection is excluded from LNR and LNY, we propose the use of a new scoring system comprising individual cut-off values for LNY and LNR with regard to the extent of neck dissection. Clinical Relevance MLNC might help to identify high-risk OSCC patients with metastatic lymph nodes.

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Evaluating the impact of the degree of extranodal extension on outcomes in locally advanced oral cavity cancer

Yalamanchali,

Griffith,

Reddy

et al. 2024

Head & Neck

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BackgroundEvaluate whether extranodal extension (ENE) extent impacts outcomes in patients with oral cavity squamous cell carcinoma (OCSCC).MethodsFrom an institutional database, patients with OCSCC and pathologic ENE who received adjuvant treatment were included. Surgical slides were reviewed to confirm ENE extent.Multivariable Cox regression was used to relate patient/treatment characteristics with disease‐free survival (DFS) and overall survival (OS). ENE was analyzed as both a dichotomous and continuous variable.ResultsA total of 113 patients were identified. Between major (>2 mm) versus minor ENE (≤2 mm), there was no significant difference in DFS (HR 1.18, 95%CI 0.72–1.92, p = 0.51) or OS (HR 1.17, 95%CI 0.70–1.96, p = 0.55). There was no significant association between ENE as a continuous variable and DFS (HR 0.97 per mm, 95%CI 0.87–1.4, p = 0.96) or OS (HR 0.96 per mm, 95%CI 0.83–1.11, p = 0.58).ConclusionNo significant relationship was seen between ENE extent and DFS or OS in individuals with OCSCC.

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Evaluation of the level of progression of extracapsular spread for cervical lymph node metastasis in oral squamous cell carcinoma

Cited by 18 publications

References 26 publications

Extranodal extension in head and neck squamous cell carcinoma: need for accurate pretherapeutic staging to select optimum treatment and minimize toxicity

Extranodal extension in head and neck squamous cell carcinoma: need for accurate pretherapeutic staging to select optimum treatment and minimize toxicity

Prognostic value of lymph node involvement in oral squamous cell carcinoma

Evaluating the impact of the degree of extranodal extension on outcomes in locally advanced oral cavity cancer

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