High‐grade radiologic extra‐nodal extension predicts distant metastasis in stage II nasopharyngeal carcinoma
Yujun Hu MD  Tianzhu Lu MD  Shao Hui Huang MSc, MD  Shaojun Lin MD  Yunbin Chen MD  Yanhong Fang MD  Han Zhou MD  Yiping Chen MD  Jingfeng Zong MD, PhD  Yu Zhang MD … See all authors
First published: 17 June 2019 https://doi.org/10.1002/hed.25842
Yujun Hu and Tianzhu Lu contributed equally to this study.
Funding information: National Natural Science Foundation of China, Grant/Award Number: U1405221; Fujian Provincial Natural Science Foundation of China, Grant/Award Numbers: 2016J01438, 2018J01275, 2019J01194; Science and Technology Program of Fujian Province, Grant/Award Number: 2018Y2003; Startup Fund for scientific research, Fujian Medical University, Grant/Award Number: 2017XQ2050
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Abstract
Background
To investigate the prognostic value of radiologic extra‐nodal extension (rENE) in stage II nasopharyngeal carcinoma (NPC).

Methods
Stage II NPC patients with N1 category (n = 365) were enrolled and divided into three groups according to the situation of rENE: without rENE, suspected rENE, and confirmed rENE (grades: A, infiltration into surrounding fat; B, matted nodes; C, infiltration into adjacent structures).

Results
Only high‐grade rENE (including matted nodes and infiltration into adjacent structures) could significantly influence the survival outcomes, patients with high‐grade rENE had significantly poorer survival than those without, with the 7‐year distant metastasis‐free survival and overall survival demonstrated to be 78.5% vs 93.0% (P < .001) and 81.9% vs 89.9% (P = .05), respectively. High‐grade rENE, as defined in our study, is a stable criterion, with high intra‐rater and inter‐rater consistency.

Conclusion
High‐grade rENE was an evaluable predictor that could help with the selection of stage II patients with high risk of distant metastasis.