Microscopic Extranodal Extension in HPV‐Negative Head and Neck Cancer and the Role of Adjuvant Chemoradiation
Bibliographic record
Abstract
Objective Pathologic extranodal extension (ENE) is an important adverse feature for human papillomavirus (HPV)–negative head and neck squamous cell carcinoma (HNSCC), but the prognostic significance of microscopic ENE (ENE mi ) and role of adjuvant concurrent chemoradiation (CRT) for ENE mi remain unclear. This study evaluates (1) the prognostic significance of ENE mi in HPV‐negative HNSCC and (2) whether adjuvant CRT is associated with improved overall survival (OS) for these patients. Study Design Retrospective cohort study. Setting Commission on Cancer (CoC)–accredited facilities. Methods This retrospective cohort study included patients in the National Cancer Database from 2009 to 2015 with pathologic node‐positive (pN+) HPV‐negative HNSCC with either pathologic ENE mi or no ENE who had undergone margin‐negative surgery. The association of ENE mi with OS was evaluated using Cox proportional hazard analyses. Analyses were repeated in patients with ENE mi receiving adjuvant therapy to evaluate the association of adjuvant CRT with OS. Results We included 5483 patients with pN+ HPV‐negative HNSCC, of whom 24% had ENE mi . On multivariable analysis, ENE mi was associated with decreased OS relative to no ENE (adjusted hazard ratio [aHR], 1.43; 95% CI, 1.28‐1.59). Among patients with ENE mi who received ≥60 Gy of adjuvant radiation therapy (RT) (n = 617), adjuvant CRT was not associated with improved OS relative to RT (aHR, 0.91; 95% CI, 0.66‐1.27). Conclusion For patients with HPV‐negative HNSCC, pN+ with ENE mi is associated with worse OS than pN+ without ENE. However, for patients with ENE mi , concurrent CRT is not associated with improved OS relative to RT. The optimal adjuvant paradigm for ENE mi requires additional investigation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".