The prognostic value of extranodal extension in human papillomavirus‐associated oropharyngeal squamous cell carcinoma

An, Yi; Park, Henry S.; Kelly, Jacqueline; Stahl, John M.; Yarbrough, Wendell G.; Burtness, Barbara; Contessa, Joseph N.; Decker, Roy H.; Koshy, Matthew; Husain, Zain

doi:10.1002/cncr.30598

Cited by 111 publications

(131 citation statements)

References 23 publications

Supporting

Mentioning

120

Contrasting

Order By: Relevance

“…Other recent studies have also demonstrated that ENE is a significant prognosticator in HPV‐positive OPSCC . The authors of these articles found ENE to confer a modest decrement in overall survival of 4% to 7%.…”

Section: Discussionmentioning

confidence: 93%

“…Instead, the pathologic system relies only on the number of positive lymph nodes for HPV‐positive OPSCC, without consideration of ENE, nodal size, or laterality . The data from which the pathologic staging system was derived showed no statistically significant association between worse outcomes and ENE in HPV‐positive OPSCC; however, more recent studies are contradictory …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2019

View full text Add to dashboard Cite

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

show abstract

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Also, we provide evidence that orthotopically transplanted LNM recapitulates all the consecutive steps of LNM progression and are functionally reconnected with the host lymphatic system. 42,43 Nevertheless, our model conveys the potential to disclose the mechanistic and cellular basis of high-risk events within LNMs such as ECS. 22,[35][36][37] This approach has mostly been described in the nononcologic settings, specifically in the context of immunerelated questions, LN function and remodeling, and in preclinical models of postsurgical lymphedema.…”

Section: Molecular Cancer Biologymentioning

confidence: 97%

Mouse model of postsurgical primary tumor recurrence and regional lymph node metastasis progression in HPV‐related head and neck cancer

Mermod

Hiou‐Feige

Bovay

et al. 2018

Intl Journal of Cancer

View full text Add to dashboard Cite

HPV-positive head and neck squamous cell carcinoma (HNSCC) is increasingly frequent. Management is particularly debated in the case of postsurgical high-risk features, that is, positive surgical margins and extracapsular spread (ECS). In this increasingly complex emerging framework of HNSCC treatment, representative preclinical models are needed to support future clinical trials and advances in personalized medicine. Here, we present an immunocompetent mouse model based on the implantation of mouse tonsil epithelial HPV16-E6/E7-expressing cancer cells into the submental region of the floor-of-the-mouth. Primary tumors were found to replicate the patterns of human HNSCC local invasion and lymphatic dissemination. To study disease progression after surgery, tumors were removed likely leaving behind residual disease. Surgical resection of tumors was followed by a high rate of local recurrences (>90%) within the first 2-3 weeks. While only 50% of mice had lymph node metastases (LNM) at time of primary tumor excision, all mice with recurrent tumors showed evidence of LNM. To study the consecutive steps of LNM progression and distant metastasis development, LNs from tumor-bearing mice were transplanted into naïve recipient mice. Using this approach, transplanted LNs were found to recapitulate all stages and relevant histological features of regional metastasis progression, including ECS and metastatic spread to the lungs. Altogether, we have developed an immunocompetent HPV-positive HNSCC mouse model of postsurgical local recurrence and regional and distant metastasis progression suitable for preclinical studies.

show abstract

“…DOI, depth of invasion. [29]. Moreover, another retrospective evaluation did not report differences between stage I and stage II [30].…”

Section: Validity Of New Tnmmentioning

confidence: 99%

“…A significant advantage was also described for PFS (HR = 0.43, 95% CI: 0. 29 In HPV-positive tumours no difference was reported among stages I-III using the 7th edition because of their good prognosis [8]. O'Sullivan et al [9] reported 5-year OS for TNM stages I, II, III, and IVA: 88% (95% CI: 74-100), 82% (95% CI: 71-95), 84% (95% CI: 79-89), and 81% (95% CI: 79-83), respectively, in HPV-positive tumours with the 7th edition.…”

Section: Oropharyngeal Cancermentioning

confidence: 99%

Pros and Cons of the New Edition of TNM Classification of Head and Neck Squamous Cell Carcinoma

Denaro

Russi

Merlano³

2018

Oncology

View full text Add to dashboard Cite

The TNM classification is a worldwide standard staging system used to define the extent of cancer and is a major prognostic factor in predicting the outcome of patients. The TNM Classification of Malignant Tumours, 8th edition, has been used since January 1, 2018. In the area of head and neck cancer major modifications were produced: important updated T and N modification for oral cavity and nasopharyngeal cancer, the introduction of clinical and pathological stages for neck disease, and a new HPV-16-positive HNSCC classification. While until a few years ago the TNM staging system classified prognostic risk groups based on tumour size, the 8th edition responds to the need to categorize the prognosis of patients with similarly sized tumours but with very different clinical and biological behaviour. This review details TNM changes and the clinical need for these modifications, valuating possible limits in daily applicability.

show abstract

The prognostic value of extranodal extension in human papillomavirus‐associated oropharyngeal squamous cell carcinoma

Cited by 111 publications

References 23 publications

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

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

Mouse model of postsurgical primary tumor recurrence and regional lymph node metastasis progression in HPV‐related head and neck cancer

Pros and Cons of the New Edition of TNM Classification of Head and Neck Squamous Cell Carcinoma

Contact Info

Product

Resources

About