Role of Extracapsular Nodal Spread and Surgical Margin Status in defining High-risk Head and Neck Squamous Cell Carcinoma and its Treatment Intensity

Abstract

High-risk head and neck squamous cell carcinoma (HNSCC) includes an ill-defined collection of tumors that share an extremely poor outcome after seemingly appropriate multimodality treatment. Accumulating evidence suggests that extracapsular nodal spread and suboptimal surgical margins may be markers of high-risk HNSCC, but their utility is limited by ambiguous pathological criteria and unsatisfactory establishment of independent prognostic value. Inaccurate definition of high-risk HNSCC continues to obscure the scientific basis of treatment intensification protocols that have been proposed for high-risk HNSCC. Recent studies propose a more objective definition of clinically relevant extracapsular nodal spread (ECS) and surgical margins, which may contribute to improved staging and treatment selection.