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Updated: Jun 17, 2026
A Model for Perineural Invasion in Head and Neck Squamous Cell Carcinoma
Published on: January 5, 2017
Structure-specific involvement in advanced cervical lymph node extranodal extension predicts prognosis in
Junyi Liu1, Yanxin Fan2, Changyong He1
1Department of Radiation Oncology, Jiangsu Key Laboratory of Innovative Cancer Diagnosis & Therapeutics, The Affiliated Cancer Hospital of Nanjing Medical University / Jiangsu Cancer Hospital / Jiangsu Institute of Cancer Research, 42 Baiziting, Nanjing 210009, China; The Fourth Clinical College of Nanjing Medical University, Nanjing 211166, China.
Objective:
To further investigate the prognostic value of advanced cervical lymph node (CLN) extranodal extension (ENE) involving different structures and its potential synergistic effects with other nodal features in nasopharyngeal carcinoma (NPC).
Methods:
A total of 1,373 non-metastatic NPC patients from three centers between 2011 and 2021 were enrolled. For advanced CLN ENE, involved structures, maximum axial diameter (MAD), necrosis, and bilaterality were recorded. Adjusted hazard ratios (AHRs) and random survival forests were used to identify the high-risk structure group. Kaplan-Meier analysis and multivariable Cox models were applied to evaluate overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS).
Results:
CLN metastasis was identified in 1135/1373 patients (82.7 %), including 169 (14.9 %) with advanced CLN ENE. The high-risk structure group comprised the hyoid muscles, scalene muscles, longissimus cervicis muscle, interval muscles, internal/external/common carotid artery, lower cranial nerves region, and skin; all other involved structures were classified as intermediate risk. Advanced CLN ENE involving high-risk structures was the only independent adverse prognostic factor after adjustment. Survival differed significantly between high-risk and intermediate-risk CLN ENE. Among N1/N2 patients, high-risk CLN ENE showed survival similar to N3 disease (AHRs > 1), whereas intermediate-risk CLN ENE showed better OS than N3, with comparable PFS and DMFS (AHRs < 1).
Conclusions:
Compared with necrosis, MAD, or bilaterality, structure-based stratification more effectively distinguished prognostic differences in advanced CLN ENE. N1/N2 patients with high-risk or intermediate-risk CLN ENE had outcomes close to N3 disease but with marked heterogeneity.
