{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T15:18:29Z","timestamp":1780499909543,"version":"3.54.1"},"reference-count":26,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp;amp; Neck"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Extranodal extension (pENE) is common in metastatic head and neck cutaneous squamous cell carcinoma (HNcSCC), but its independent prognostic value is unclear. This study assessed whether pENE extent influences survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort of patients with metastatic HNcSCC treated surgically at Chris O'Brien Lifehouse (2015\u20132023) was analyzed. pENE was defined as tumor extension beyond the nodal capsule or soft\u2010tissue deposits. Survival was assessed using Kaplan\u2013Meier and Cox regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 585 patients, 81.5% had pENE, most commonly &gt;\u200915\u2009mm. Extensive pENE was associated with worse overall and disease\u2010free survival on univariate analysis, but not after multivariable adjustment. Independent predictors of poorer outcomes included age, nodal size, nodal number, perineural invasion, and positive margins. pENE strongly correlated with nodal burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>pENE is highly prevalent in metastatic HNcSCC but lacks independent prognostic significance. More discriminatory, HNcSCC\u2010specific nodal staging criteria are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.70227","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T13:45:38Z","timestamp":1772977538000},"page":"1702-1708","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Extranodal Extension in Patients With Regional Metastases of Head and Neck Cutaneous Squamous Cell Carcinoma"],"prefix":"10.1002","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8484-9557","authenticated-orcid":false,"given":"Rachel","family":"Braude","sequence":"first","affiliation":[{"name":"Chris O'brien Lifehouse Sydney Head and Neck Cancer Institute  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson Luna","family":"Guzman","sequence":"additional","affiliation":[{"name":"Chris O'brien Lifehouse Sydney Head and Neck Cancer Institute  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan R.","family":"Clark","sequence":"additional","affiliation":[{"name":"Chris O'brien Lifehouse Sydney Head and Neck Cancer Institute  Sydney New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health Sciences University of Sydney  Sydney New South Wales Australia"},{"name":"Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruta","family":"Gupta","sequence":"additional","affiliation":[{"name":"Chris O'brien Lifehouse Sydney Head and Neck Cancer Institute  Sydney New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health Sciences University of Sydney  Sydney New South Wales Australia"},{"name":"Department of Tissue Pathology and Diagnostic Oncology Royal Prince Alfred Hospital, NSW Health Pathology  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Fielder","sequence":"additional","affiliation":[{"name":"Chris O'brien Lifehouse Sydney Head and Neck Cancer Institute  Sydney New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health Sciences University of Sydney  Sydney New South Wales Australia"},{"name":"Department of Tissue Pathology and Diagnostic Oncology Royal Prince Alfred Hospital, NSW Health Pathology  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8538-3132","authenticated-orcid":false,"given":"Kerwin F.","family":"Shannon","sequence":"additional","affiliation":[{"name":"Chris O'brien Lifehouse Sydney Head and Neck Cancer Institute  Sydney New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health Sciences University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten E.","family":"Palme","sequence":"additional","affiliation":[{"name":"Chris O'brien Lifehouse Sydney Head and Neck Cancer Institute  Sydney New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health Sciences University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Elliott","sequence":"additional","affiliation":[{"name":"Chris O'brien Lifehouse Sydney Head and Neck Cancer Institute  Sydney New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health Sciences University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Wykes","sequence":"additional","affiliation":[{"name":"Chris O'brien Lifehouse Sydney Head and Neck Cancer Institute  Sydney New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health Sciences University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sydney","family":"Ch'ng","sequence":"additional","affiliation":[{"name":"Chris O'brien Lifehouse Sydney Head and Neck Cancer Institute  Sydney New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health Sciences University of Sydney  Sydney New South Wales Australia"},{"name":"Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Manzie","sequence":"additional","affiliation":[{"name":"Chris O'brien Lifehouse Sydney Head and Neck Cancer Institute  Sydney New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health Sciences University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3791-4925","authenticated-orcid":false,"given":"Leba Michael","family":"Sarkis","sequence":"additional","affiliation":[{"name":"Chris O'brien Lifehouse Sydney Head and Neck Cancer Institute  Sydney New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health Sciences University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsu\u2010Hui","family":"Low","sequence":"additional","affiliation":[{"name":"Chris O'brien Lifehouse Sydney Head and Neck Cancer Institute  Sydney New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health Sciences University of Sydney  Sydney New South Wales Australia"},{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Faculty of Medicine and Health Sciences Macquarie University  Sydney New South Wales 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