The importance of extranodal extension in metastatic head and neck squamous cell carcinoma, in the light of the new AJCC cancer staging system

We have read with great interest the manuscript by Mermod et al. [1], in which the prognostic role of extranodal extension (ENE) of lymph node metastasis in head and neck squamous cell carcinoma (SCC) has been investigated through a meta-analytic approach. The main results, shown by Mermod et al., indicate a negative impact of ENE on loco-regional recurrence and distant metastasis in head and neck SCC, as well as an absence of such negative impact of ENE in HPV-positive oropharyngeal SCC. These results confirm the negative prognostic role of ENE in head and neck SCC, but also point out a biological peculiarity of this prognostic moderator, since its role is not significant in influencing the prognosis in case of HPV-positive cancers.

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