title: Extent of pathologic extracapsular extension and outcomes in patients with nonoropharyngeal head and neck cancer treated with initial surgical resection.
abstract: BACKGROUND
  Lymph node extracapsular extension (ECE) is a known adverse prognostic factor in head and neck cancer and is an indication for adjuvant chemoradiation (CRT). However, the extent of ECE may provide additional prognostic information in the setting of adjuvant CRT.
  
  
  METHODS
  This study included 350 patients with oral cavity cancer (72.6%) or bulky/nonfunctional laryngeal cancer (27.4%) who underwent initial surgical resection. Extent of ECE was graded from 0 to 4 based on the scale established by Lewis and colleagues. Multivariable analyses (MVA) were adjusted for primary site, pathologic risk factors, and adjuvant therapy.
  
  
  RESULTS
  In univariate failure-free survival (FFS) analysis, there was no significant difference in FFS for patients with lymph node-positive disease and no ECE (grade 0) versus patients with ECE grades 1 through 3. However, patients with ECE grade 4 had significantly worse FFS. In MVA for FFS, differences between ECE grades 0 through 3 and grade 4 did not remain significant. In MVA of overall survival, ECE grade 4 was significantly associated with higher risk of death compared with ECE grade 0 (hazard ratio, 0.46; P = .02) and ECE grades 1 through 3 (HR, 0.41; P = .01).
  
  
  CONCLUSIONS
  Dichotomous evaluation of ECE is useful for determining appropriate adjuvant therapy but has limited additional prognostic value in the setting of adjuvant CRT. The detrimental effect of ECE grades 1 through 3 relative to no ECE is effectively mitigated with adjuvant CRT, but ECE grade 4 retains a poorer prognosis despite CRT with regard to overall survival. Patients with ECE grade 4 may be candidates for trials investigating novel methods of adjuvant therapy intensification.
authors: Southeast Radiation Oncology Group, Levine Cancer Institute, Charlotte, North Carolina.
authors: Roshan S
authors: RS
authors: Prabhu
authors: Sheela
authors: S
authors: Hanasoge
authors: Kelly R
authors: KR
authors: Magliocca
authors: Benjamin J
authors: BJ
authors: Moeller
authors: Zvonimir L
authors: ZL
authors: Milas
authors: William A
authors: WA
authors: Hall
authors: Mark
authors: M
authors: El-Deiry
authors: J Trad
authors: JT
authors: Wadsworth
authors: Kristen A
authors: KA
authors: Higgins
authors: Jonathan J
authors: JJ
authors: Beitler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery; D015999:Multivariate Analysis; D037981:Neck Dissection; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors
keywords: adjuvant chemoradiotherapy; adjuvant radiotherapy; extracapsular extension; head and neck cancer; larynx cancer; oral cavity cancer