ArticleModern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc2022
Prognostic impact of extranodal extension (ENE) in surgically managed treatment-naive HPV-positive oropharyngeal squamous cell carcinoma with nodal metastasis.
Article in Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.
- Systematic review of artificial intelligence and radiomics for preoperative prediction of extranodal extension and lymph node metastasis in oropharyngeal cancer.Frontiers in oncology · 2025Pooled it
- Correlation between imaging-detected and pathological extranodal extension in a randomised trial in Human Papillomavirus-positive oropharyngeal cancer.British journal of cancer · 2026Trial
- Article
- Prognostic value of the number of imaging-detected lymph node metastases diagnosed by combined FDG-PET/CT and Node-RADS in HPV-associated oropharyngeal carcinoma.European radiology · 2026Article
- Article
- HPV-associated Oropharyngeal Squamous Cell Carcinoma: An Imaging Framework for AJCC Version 9 TNM Staging.Radiology. Imaging cancer · 2026Review
- CT-based Extranodal Extension for Nodal Staging and Prognostic Stratification in Surgically Resectable Esophageal Squamous Cell Carcinoma.Radiology. Imaging cancer · 2026Observational
- Lymph Node Metastasis in Head and Neck Squamous Cell Carcinoma: Evolving Prognostic Markers, Molecular Insights, and Implications for Precision Staging.Diagnostics (Basel, Switzerland) · 2026Review
- Association Between Nutritional Status and Extranodal Extension of Lymph Node Metastases in Head and Neck Squamous Cell Cancers.Nutrients · 2026Article
- Automated Lymph Node and Extranodal Extension Assessment Improves Risk Stratification in Oropharyngeal Carcinoma.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2026Article
- CT-based texture analysis for preoperative prediction of key histopathological features in laryngeal cancer.Polish journal of radiology · 2026Article
- Derivation and validation of the AJCC9V pathological stage classification for HPV-positive oropharyngeal carcinoma: a multicentre registry analysis.The Lancet. Oncology · 2025Article
- PET/MR for predicting extranodal extension of head and neck cancer.Neuroradiology · 2025Article
- Preoperative Nodal Biopsy and Extranodal Extension in p16+ Oropharyngeal Squamous Cell Carcinoma.Laryngoscope investigative otolaryngology · 2025Article
- Radiological extranodal extension in head and neck cancers: current evidence and challenges in imaging detection and prognostic impact.BJR open · 2025Review
- [Advances in the diagnosis and prognosis of extranodal extension in head and neck squamous cell carcinoma].Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology head and neck surgery · 2024Review
- Review
- The prognostic effect of radiological extranodal extension in HPV-positive oropharyngeal squamous cell carcinomas: a retrospective cohort analysis.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2024Article
- CT radiomic signature predicts survival and chemotherapy benefit in stage I and II HPV-associated oropharyngeal carcinoma.NPJ precision oncology · 2023Article
- Real world practice of postoperative radiotherapy for patients with completely resected pIIIA-N2 non-small cell lung cancer: a national survey of radiation oncologists in China.Radiation oncology (London, England) · 2023Article
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Authors and funding
11 authors at 3 institutions in 1 country.
Funding
Abstract
Extranodal extension (ENE) is a significant prognostic factor for human papilloma virus (HPV)-negative head and neck squamous cell carcinoma and is incorporated into AJCC 8th edition pN stage. It remains controversial whether ENE or the degree of ENE is prognostically relevant in HPV-positive oropharyngeal squamous cell carcinoma (OPSCC). A detailed clinicopathologic review was conducted in a large retrospective cohort of 232 surgically treated patients with HPV-positive OPSCC and nodal metastasis. Fifty-six patients (24%) had nodal metastasis with ENE. The median vertical extent of ENE was 2.9 mm (range 0.2-20.3 mm), and the median horizontal span of ENE was 2.5 mm (range: 0.3-14.0 mm). Comparing with patients without ENE, those with ENE were associated with a higher number of positive lymph nodes, lymphovascular invasion, perineural invasion, adjuvant chemotherapy, larger primary tumor size, and shorter follow up period. Patients with ENE had shortened overall survival (OS), disease specific survival (DSS), disease free survival (DFS), distant metastasis free survival (DMFS), and regional recurrence free survival (RRFS) on univariate survival analysis. The 5-year OS, DSS, and DFS were 95%, 97%, and 90% respectively for the group without ENE, and 64%, 71%, and 65% respectively for the group with ENE. On Multivariate survival analysis, the presence of ENE was an independent adverse prognostic factor for OS, DSS, and DFS. Additionally, major ENE defined as a vertical extent of ≥4 mm or irregular soft tissue deposit independently predicted shortened OS, DSS, and RFS. In conclusion, the presence of ENE, in particular major ENE, is an independent prognostic factor in HPV-positive OPSCC. Therefore, we propose to document the presence and extent of ENE for these tumors. Consideration may be given for AJCC 9th edition to include ENE into pN stage of HPV-positive OPSCC.
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