title: Extracapsular spread in head and neck squamous cell carcinoma: A systematic review and meta-analysis.
abstract: Extracapsular spread (ECS) is one of the most important prognostic factors in head and neck squamous cell carcinoma (HNSCC). However, despite its major clinical relevance, there are still a number of important remaining issues regarding this condition. Indeed, standardized diagnostic and grading criteria of ECS are still lacking. The imaging modality of choice for its diagnosis is a matter of debate. Current research looking at the identification of specific biomarkers is ongoing. Recent findings demonstrate a direct correlation between the level of extension of ECS and a poor prognosis. Accumulating data show that ECS does not carry the same adverse features in human papilloma virus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). New treatment strategies based on these factors are currently considered to investigate the possibility of diminishing the toxicity of chemo-radiotherapy while maintaining similar outcomes. The goal of this article was to provide a systematic review of the literature covering all the issues related to ECS. As an additional component of the review, meta-analyses were performed on relevant aspects of ECS for which previous quantitative data were outdated or not available. The results of these meta-analyses confirm the negative impact of ECS on loco-regional recurrence and distant metastasis. They also demonstrate the absence of a negative impact of ECS in HPV-positive OPSCC.
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery, Head & Neck Tumor Laboratory, CHUV, University Hospital, Lausanne, Switzerland.
authors.forename: Maxime
authors.initials: M
authors.lastname: Mermod
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery, Head & Neck Tumor Laboratory, CHUV, University Hospital, Lausanne, Switzerland.
authors.forename: Genrich
authors.initials: G
authors.lastname: Tolstonog
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery, Head & Neck Tumor Laboratory, CHUV, University Hospital, Lausanne, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Simon
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery, Head & Neck Tumor Laboratory, CHUV, University Hospital, Lausanne, Switzerland. Electronic address: yan.monnier@chuv.ch.
authors.forename: Yan
authors.initials: Y
authors.lastname: Monnier
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: Extracapsular spread; Extranodal spread; HPV; Head and neck squamous cell carcinoma; Lymph node metastasis; Meta-analysis; Perinodal spread; Systematic review; Transcapsular spread