Extranodal extension in laryngeal squamous cell carcinoma

Area of Science:

• Oncology
• Head and Neck Surgery
• Cancer Prognostics

Background:

• Extranodal extension (ENE) is linked to poorer survival in head and neck cancers, but its prognostic value in laryngeal squamous cell carcinoma (LSCC) is not well-established.
• Understanding ENE's impact is crucial for accurate prognosis and treatment planning in LSCC.

Purpose of the Study:

• To investigate the prognostic significance of extranodal extension (ENE) on overall survival (OS) in patients with laryngeal squamous cell carcinoma (LSCC).
• To determine if ENE is an independent prognostic factor in LSCC, irrespective of pN classification.

Main Methods:

• Retrospective analysis of the National Cancer Database (2006-2017) for LSCC patients undergoing surgical resection and neck dissection.
• Kaplan-Meier and multivariable Cox regression analyses were used to assess the impact of ENE and pN classification on OS.

Main Results:

• Of 4208 patients, 19.2% had pN1-2/ENE-positive disease, with a 5-year OS of 32.9% compared to 62.8% for pN0/ENE-negative and 56.7% for pN1-2/ENE-negative.
• ENE-positivity was independently associated with worse OS (aHR 1.76, p < .001), with both microscopic and macroscopic ENE showing significant negative prognostic impact.
• Adjuvant therapy, particularly chemoradiotherapy, improved OS in pN1-2/ENE-positive patients.

Conclusions:

• Extranodal extension (ENE) is a significant independent prognostic factor for worse overall survival (OS) in laryngeal squamous cell carcinoma (LSCC).
• ENE status is more critical for prognosis than pN classification alone in LSCC.
• Careful consideration of ENE is essential for determining LSCC prognosis and guiding adjuvant therapy decisions.