title: Prognostic value of radiographic extracapsular extension in locally advanced head and neck squamous cell cancers.
abstract: OBJECTIVE
  We investigated associations between radiographic evidence of nodal extracapsular extension (rECE) and outcomes for locally advanced head and neck squamous cell cancers (LAHNC).
  
  
  METHODS
  We conducted a single-institution retrospective study of 258 consecutive LAHNC patients with accessible pretreatment contrast-enhanced neck CT scans, who completed definitive or adjuvant radiation therapy. All scans were reviewed by an expert head and neck radiologist for evidence of rECE. Kaplan-Meier and Cox regression multivariate analyses (MVA) were performed to evaluate the impact of rECE on overall survival (OS), progression free survival (PFS), distant control (DC), and locoregional control (LRC).
  
  
  RESULTS
  One-hundred forty patients were rECE-positive and 118 were rECE-negative. The rECE-positive cohort had more cN3 disease (11.6% vs. 0.8%) and heavier smoking histories (60.0% vs. 44.9% with ⩾10-pack-years). The rECE-positive cohort had significantly worse 3-year OS (64.3% vs. 82.8%, p=0.002), PFS (58.9% vs. 76.0%, p=0.001), DC (72.3% vs. 90.6%, p<0.001), and LRC (75.9% vs. 89.8%, p=0.002). On MVA, rECE independently predicted for worse OS, PFS, DC, and LRC for LAHNC overall. On subset analysis of HPV-positive oropharyngeal cancers, rECE was not a significant prognosticator.
  
  
  CONCLUSIONS
  For all sites of LAHNC, except HPV-positive oropharyngeal cancers, presence of rECE independently predicts for worse disease control and survival. Further studies are needed to validate these findings and demonstrate whether rECE may be considered for risk-stratifying patients for clinical trial design and treatment decisions.
authors.affiliation: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States. Electronic address: Jerry.Liu@mountsinai.org.
authors.forename: Jerry T
authors.initials: JT
authors.lastname: Liu
authors.affiliation: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Kann
authors.affiliation: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: De
authors.affiliation: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Buckstein
authors.affiliation: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Bakst
authors.affiliation: Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Genden
authors.affiliation: Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States.
authors.forename: Marshall R
authors.initials: MR
authors.lastname: Posner
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Som
authors.affiliation: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States.
authors.forename: Vishal
authors.initials: V
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
keywords: Computed tomography; Extracapsular extension; Head and neck cancer; Lymph nodes; Prognostic factors