Faculty Collaboration Database

Microscopic Extranodal Extension in HPV-Negative Head and Neck Cancer and the Role of Adjuvant Chemoradiation. Otolaryngol Head Neck Surg 2021 Oct;165(4):536-549

Date

02/24/2021

Pubmed ID

33618570

Pubmed Central ID

PMC8380754

DOI

10.1177/0194599821989637

Scopus ID

2-s2.0-85101742192 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

OBJECTIVE: Pathologic extranodal extension (ENE) is an important adverse feature for human papillomavirus (HPV)-negative head and neck squamous cell carcinoma (HNSCC), but the prognostic significance of microscopic ENE (ENE_mi) and role of adjuvant concurrent chemoradiation (CRT) for ENE_mi remain unclear. This study evaluates (1) the prognostic significance of ENE_mi in HPV-negative HNSCC and (2) whether adjuvant CRT is associated with improved overall survival (OS) for these patients.

STUDY DESIGN: Retrospective cohort study.

SETTING: Commission on Cancer (CoC)-accredited facilities.

METHODS: This retrospective cohort study included patients in the National Cancer Database from 2009 to 2015 with pathologic node-positive (pN+) HPV-negative HNSCC with either pathologic ENE_mi or no ENE who had undergone margin-negative surgery. The association of ENE_mi with OS was evaluated using Cox proportional hazard analyses. Analyses were repeated in patients with ENE_mi receiving adjuvant therapy to evaluate the association of adjuvant CRT with OS.

RESULTS: We included 5483 patients with pN+ HPV-negative HNSCC, of whom 24% had ENE_mi. On multivariable analysis, ENE_mi was associated with decreased OS relative to no ENE (adjusted hazard ratio [aHR], 1.43; 95% CI, 1.28-1.59). Among patients with ENE_mi who received ≥60 Gy of adjuvant radiation therapy (RT) (n = 617), adjuvant CRT was not associated with improved OS relative to RT (aHR, 0.91; 95% CI, 0.66-1.27).

CONCLUSION: For patients with HPV-negative HNSCC, pN+ with ENE_mi is associated with worse OS than pN+ without ENE. However, for patients with ENE_mi, concurrent CRT is not associated with improved OS relative to RT. The optimal adjuvant paradigm for ENE_mi requires additional investigation.

Author List

Yan F, Li H, de Almeida JR, Kaczmar JM, Pipkorn P, Zenga J, Richardson MS, Neskey DM, Sharma AK, Day TA, Graboyes EM

Author

Joseph Zenga MD Assistant Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Carcinoma, Squamous Cell
Chemoradiotherapy, Adjuvant
Head and Neck Neoplasms
Humans
Male
Margins of Excision
Middle Aged
Neck Dissection
Prognosis
Retrospective Studies
Survival Rate
United States