Prognostic value of radiographically defined extranodal extension in human papillomavirus-associated locally advanced oropharyngeal carcinoma

Head Neck. 2019 Sep;41(9):3056-3063. doi: 10.1002/hed.25791. Epub 2019 May 2.


Background: Pathologic extranodal extension (ENE) has traditionally guided the management of head and neck cancers. The prognostic value of radiographic ENE (rENE) in human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (HPV + OPX) is uncertain.

Methods: Patients with HPV + OPX with adequate pretreatment radiographic nodal evaluation from a single institution were analyzed. rENE status was determined by neuroradiologists' at time of diagnosis. Distant metastasis-free survival (DMFS), overall survival (OS), and locoregional recurrence-free survival (LRFS) were estimated using Kaplan-Meier methods. Cox proportional hazards models were fit to assess the impact of rENE on survival endpoints.

Results: Hundred sixty-eight patients with OPX + squamous cell carcinomas diagnosed between April 2008 and December 2014 were included for analysis with median follow-up of 3.3 years. Eighty-eight percent of patients received concurrent chemoradiotherapy. rENE was not prognostic; its presence in patients with HPV + OPX did not significantly impact OS, LRFS, or DMFS.

Conclusions: In patients with HPV + OPX, rENE was not significantly associated with OS, LRFS, or DMFS.

Keywords: ENE; HPV; extranodal extension; oropharynx cancer; p16.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Carcinoma, Squamous Cell / diagnostic imaging
  • Carcinoma, Squamous Cell / secondary*
  • Carcinoma, Squamous Cell / virology
  • Chemoradiotherapy
  • Disease-Free Survival
  • Extranodal Extension / diagnostic imaging*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Oropharyngeal Neoplasms / diagnostic imaging
  • Oropharyngeal Neoplasms / pathology*
  • Oropharyngeal Neoplasms / virology
  • Papillomavirus Infections / complications*
  • Prognosis
  • Proportional Hazards Models
  • Radiography