{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T02:18:20Z","timestamp":1787883500476,"version":"build-2784847793"},"reference-count":31,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T00:00:00Z","timestamp":1674086400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>The American Joint Committee on Cancer's 8th edition (AJCC\u20108) separates oropharyngeal squamous cell carcinomas (OPSCCs) into human papillomavirus\u2010positive (HPV+) tumors and HPV\u2010negative tumors. Although AJCC\u20108 improves prognostic prediction for survival for the majority of HPV+ OPSCC, outliers are still encountered. The goal of this manuscript is to validate the AJCC\u20108 as a better metric of survivability than the AJCC\u20107 in an historically under\u2010served rural population with confounding variables, such as tobacco use, alcohol consumption, and poor health care access and to analyze the role of extranodal extension (ENE) in this population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to AJCC\u20107, AJCC\u20108 had a higher odds ratio (OR) for predicting mortality of stage IV HPV+ OPSCCs versus stages I\u2013III. On multivariate analysis, HPV+ OPSCCs with ENE had a higher OR of mortality compared to ENE\u2010 OPSCCs. In addition, HPV+ OPSCC patients with a Charlson Comorbidity Index (CCI)\u2009&gt;\u20093 had a higher OR of mortality compared to those with a CCI\u2009\u2264\u20093. Patients with Medicaid\/self\u2010pay status had a higher OR of mortality compared to those with private insurance\/Medicare. Finally, patients from rural populations had a higher OR of presenting with stage IV disease, a CCI\u2009&gt;\u20093, and Medicaid\/self\u2010pay status.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite not being a discrete part of the AJCC\u20108 staging rubric, ENE was found to have a significant impact on mortality among this population, whereas tobacco use had no effect. Rural patients were more likely to present with stage IV disease, CCI\u2009&gt;\u20093, and Medicaid\/self\u2010pay status. Stage IV disease was also associated with a higher OR of mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 133:2621\u20132626, 2023<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.30572","type":"journal-article","created":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T11:15:11Z","timestamp":1674126911000},"page":"2621-2626","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Extranodal Extension Improves <scp>AJCC<\/scp>\u20108 Accuracy in <scp>HPV<\/scp>+ Oropharyngeal Cancer in a <scp>High\u2010Risk<\/scp> Population"],"prefix":"10.1002","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3296-654X","authenticated-orcid":false,"given":"Clayton Prakash","family":"Burruss","sequence":"first","affiliation":[{"name":"University of Kentucky College of Medicine  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Sharrer","sequence":"additional","affiliation":[{"name":"University of Kentucky College of Medicine  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James Zachary","family":"Porterfield","sequence":"additional","affiliation":[{"name":"University of Kentucky Department of Otolaryngology\u2010Head and Neck Surgery  Lexington Kentucky USA"},{"name":"University of KwaZulu\u2010Natal Department of Otorhinolaryngology  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1999-2818","authenticated-orcid":false,"given":"Alexandra Eva","family":"Kejner","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina Department of Otolaryngology  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,1,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6915a1"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jop.12535"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.5539\/cco.v2n1p51"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.31416"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2018.07.013"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-68380-w"},{"key":"e_1_2_8_8_1","unstructured":"Prevention CfDCa. 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