Extent of pathologic extracapsular extension and outcomes in patients with nonoropharyngeal head and neck cancer treated with initial surgical resection

Abstract

BACKGROUND: Lymph node extracapsular extension (ECE) is a known adverse prognostic factor in head and neck cancer and is an indication for adjuvant chemoradiation (CRT). However, the extent of ECE may provide additional prognostic information in the setting of adjuvant CRT. METHODS: This study included 350 patients with oral cavity cancer (72.6%) or bulky/nonfunctional laryngeal cancer (27.4%) who underwent initial surgical resection. Extent of ECE was graded from 0 to 4 based on the scale established by Lewis and colleagues. Multivariable analyses (MVA) were adjusted for primary site, pathologic risk factors, and adjuvant therapy. RESULTS: In univariate failure-free survival (FFS) analysis, there was no significant difference in FFS for patients with lymph nodepositive disease and no ECE (grade 0) versus patients with ECE grades 1 through 3. However, patients with ECE grade 4 had significantly worse FFS. In MVA for FFS, differences between ECE grades 0 through 3 and grade 4 did not remain significant. In MVA of overall survival, ECE grade 4 was significantly associated with higher risk of death compared with ECE grade 0 (hazard ratio, 0.46; P 5.02) and ECE grades 1 through 3 (HR, 0.41; P 5.01). CONCLUSIONS: Dichotomous evaluation of ECE is useful for determining appropriate adjuvant therapy but has limited additional prognostic value in the setting of adjuvant CRT. The detrimental effect of ECE grades 1 through 3 relative to no ECE is effectively mitigated with adjuvant CRT, but ECE grade 4 retains a poorer prognosis despite CRT with regard to overall survival. Patients with ECE grade 4 may be candidates for trials investigating novel methods of adjuvant therapy intensification. Cancer 2014;120:1499

Histopathological factors influencing results of combined treatment in patients with laryngeal cancer

“…Furthermore, DFS and OS were negatively affected by ECE confirmed by histological examination. Similar observations have been reported by other authors [19,32,35,40,41,42]. Peters et al [17] support the significant effects of ECE on combined treatment outcomes.…”

Radiographic Imaging Does Not Reliably Predict Macroscopic Extranodal Extension in Human Papilloma Virus-Associated Oropharyngeal Cancer

“…Much of the data examining the performance of modern cross-sectional imaging to determine radiographic ENE (rENE) in comparison to pENE is based on data from nonoropharyngeal SCCHN as these are the groups that routinely undergo upfront elective neck dissection [1,3,4]. In our experience, although radiographic sensitivity is poor, specificity in predicting pENE for nonoropharyngeal cancers is quite good [8].…”

“…To predict ENE in this study, we looked at a number of radiographic features, with a focus on perinodal stranding (Fig. 1, 2), the primary feature used to predict ENE in our prior study of nonoropharyngeal SCC where our sensitivity and specificity for identifying ENE was 43.7 and 97.7% [3]. When perinodal stranding was applied to this oropharyngeal cohort, the false positive rate was unacceptably high.…”

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

“…13,14 However, few studies have examined the level of progression of ECS as an indication for CCRT. 6,7,10 The aim of the present study was to evaluate the efficacy of the level of progression of ECS in OSCC patients at a high risk of recurrence in identifying those patients who would benefit most from the intensification of adjuvant therapy. The results of this study may improve the postoperative management of patients with advanced OSCC.…”

“…The extracapsular spread of cervical lymph node metastasis has previously been identified as a strong prognostic factor in OSCC patients at a high risk of recurrence. [5][6][7][8][9][10] In 2004, the European Organisation for Research and Treatment of Cancer (EORTC) and the Radiation Therapy Oncology Group (RTOG) reported the findings of two randomized trials (EORTC trial 22931 and RTOG trial 9501) that evaluated the role of concomitant chemotherapy-enhanced radiation therapy (CCRT) in a postoperative setting for head and neck squamous cell carcinoma (HNSCC) patients at high risk of recurrence and metastasis including ECS. 11,12 Concurrent chemoradiotherapy with a high dose of the single agent cisplatin has recently been recognized worldwide as the standard treatment for patients with resectable, advanced HNSCC who are at high risk of recurrence and metastasis.…”