Imaging Extranodal Extension (iENE) Predicts Higher Rates of Distant Recurrence for Human Papillomavirus-Positive...

Area of Science:

• Oncology
• Radiology
• Head and Neck Cancer Research

Background:

• Pathologic extranodal extension (ENE) is a known poor prognostic factor in head and neck cancers.
• Limited data exist on the prognostic value of imaging-identified extranodal extension (iENE) in oropharyngeal cancer (OPC).

Purpose of the Study:

• To evaluate the prognostic significance of iENE in human papillomavirus-positive (HPV+) OPC patients.
• To assess the association between iENE grade and clinical outcomes.

Main Methods:

• Retrospective analysis of 421 HPV+ OPC patients (Stage I-III) treated with curative intent (2009-2020).
• Pretreatment CT or MRI assessed for iENE by two blinded neuroradiologists.
• Cox-proportional hazards models analyzed time-to-event outcomes, controlling for relevant clinical factors.

Main Results:

• 134 patients were iENE-negative and 287 were iENE-positive; 271 had grade 2 or 3 iENE.
• iENE-positive patients had significantly decreased progression-free survival (PFS) (HR 2.01, p=.007) and increased distant metastases (HR 2.36, p=.031).
• Grade 3 iENE was associated with increased risk of death/recurrence (PFS HR 3.56, p≤.001) and distant recurrence (HR 3.37, p=.007).

Conclusions:

• iENE, particularly grade 3, is a significant predictor of decreased PFS and increased distant metastases in HPV+ OPC.
• Incorporating iENE into staging may enhance prognostication for HPV+ OPC.
• Findings can inform clinical trial design for HPV+ OPC.