{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T16:12:33Z","timestamp":1788797553928,"version":"build-2803163510"},"reference-count":44,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Extranodal extension (ENE) is a recognized adverse prognostic factor in oropharyngeal squamous cell carcinoma (OPSCC). However, most evidence concerns clinical ENE, whereas data on pathologic ENE (pENE) are limited. With the renewed role of surgery in the management of OPSCC, this study evaluates the prognostic significance of pENE according to HPV status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Multicenter retrospective cohort conducted from 2010 to 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Specialized otolaryngology\u2013head and neck surgery European departments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients aged 18 years or older who underwent primary surgery for OPSCC of the tonsil or base of tongue were included. HPV status was based on p16 expression assessed by immunohistochemistry. pENE was classified as present or absent. We estimated overall survival (OS), disease\u2010free survival (DFS), and recurrence patterns, adjusting for competing risks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 650 patients, 284 (43.7%) were p16\u2010positive and 166 (25.5%) reported presence of pENE. In p16\u2010negative patients, those with pENE showed a worse 5\u2010year DFS (35.6% vs 43.5%; adjusted HR [aHR], 1.64; 95% CI, 1.09\u20102.46) and OS (43.3% vs 52.0%; aHR, 1.76, 95% CI, 1.14\u20102.73) than those without. Cumulative incidence of recurrence was significantly higher in p16\u2010negative patients with pENE (55.8% vs 37.0%). pENE was significantly associated with increased risk of distant metastases only in p16\u2010negative patients (21.0% vs 7.6%; aHR, 2.52; 95% CI, 1.03\u2010625).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The prognostic role of pENE in OPSCC appears to differ by HPV status. These findings underline the importance of considering HPV status when interpreting the prognostic significance of pENE.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.70234","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T13:19:32Z","timestamp":1776172772000},"page":"1541-1551","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Recurrences and Survival in Oropharyngeal Squamous Cell Carcinoma According to p16 Status and Extranodal Extension"],"prefix":"10.1002","volume":"174","author":[{"given":"Paolo","family":"Boscolo\u2010Rizzo","sequence":"first","affiliation":[{"name":"Department of Medical Surgical and Health Sciences, Section of Otolaryngology, University of Trieste Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4160-3479","authenticated-orcid":false,"given":"Fabiola","family":"Giudici","sequence":"additional","affiliation":[{"name":"Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry","family":"Polesel","sequence":"additional","affiliation":[{"name":"Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Tagliabue","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery European Institute of Oncology, IRCCS Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Egidio","family":"Sia","sequence":"additional","affiliation":[{"name":"Department of Medical Surgical and Health Sciences, Section of Otolaryngology, University of Trieste Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittorio","family":"Rampinelli","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Brescia Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Stellin","sequence":"additional","affiliation":[{"name":"Unit of Otolaryngology, AULSS 2\u2010Marca Trevigiana Treviso Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enzo","family":"Emanuelli","sequence":"additional","affiliation":[{"name":"Unit of Otolaryngology, AULSS 2\u2010Marca Trevigiana Treviso Italy"},{"name":"Department of Neurosciences Section of Otolaryngology, University of Padova Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi A.","family":"Vaira","sequence":"additional","affiliation":[{"name":"Department of Medicine Surgery and Pharmacy, Maxillofacial Surgery Operative Unit, University of Sassari Sassari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Zucchini","sequence":"additional","affiliation":[{"name":"Department of Medical Surgical and Health Sciences, Section of Otolaryngology, University of Trieste Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawel","family":"Golusinski","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Maxillofacial Surgery University of Zielona G\u00f3ra Zielona G\u00f3ra Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier","family":"Dequanter","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery CHU Saint\u2010Pierre Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Chiesa\u2010Estomba","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head &amp; Neck Surgery Hospital Universitario Donostia San Sebastian Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonino","family":"Maniaci","sequence":"additional","affiliation":[{"name":"Provincial Health Authority (ASP), Giovanni II Hospital Ragusa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Lentini","sequence":"additional","affiliation":[{"name":"Provincial Health Authority (ASP), Giovanni II Hospital Ragusa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"De Berardinis","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery European Institute of Oncology, IRCCS Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mateusz","family":"Szewczyk","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Poznan University of Medical Sciences, The Greater Poland Cancer Center Poznan Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome R.","family":"Lechien","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery CHU Saint\u2010Pierre Brussels Belgium"},{"name":"Department of Otolaryngology\u2010Head Neck Surgery Elsan Hospital Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesare","family":"Piazza","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Brescia Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piero","family":"Nicolai","sequence":"additional","affiliation":[{"name":"Unit of Otolaryngology, AULSS 2\u2010Marca Trevigiana Treviso Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohssen","family":"Ansarin","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head 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