Imaging-Detected Extranodal Extension Linked to Worse Survival in HPV-Positive OPC

A secondary analysis of the RTOG 1016 trial evaluated imaging-detected extranodal extension (iENE) on CT simulation scans in 586 patients with HPV-positive, node-positive oropharyngeal cancer. The study reported that iENE, present in 60% of patients, was associated with inferior 5-year overall survival (79.2% vs 87.0%) and progression-free survival (68.8% vs 80.4%), and remained independently associated with worse outcomes on multivariate analysis. The authors state that the updated TNM9 nodal staging system, which upstages iENE-positive disease, discriminates better between patient outcomes than the prior TNM8 system, though C-index and AIC values were similar between the two systems.

Most relevant for: Patients with HPV-mediated (p16-positive) oropharyngeal cancer with clinically node-positive disease.

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