{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T13:39:10Z","timestamp":1794490750518,"version":"4.9.1"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Arch Otorhinolaryngol"],"published-print":{"date-parts":[[2025,10]]},"DOI":"10.1007\/s00405-025-09546-y","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T15:35:25Z","timestamp":1751643325000},"page":"5265-5273","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Even microscopic extranodal extension has significant recurrent and metastatic potential in oral squamous cell carcinoma"],"prefix":"10.1007","volume":"282","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1768-8951","authenticated-orcid":false,"given":"Takuma","family":"Morita","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Sasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukiko","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirofumi","family":"Fukushima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wataru","family":"Shimbashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Seto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Koizumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Kamiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazunori","family":"Ichikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Toshiyasu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syunji","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Mitani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,4]]},"reference":[{"key":"9546_CR1","doi-asserted-by":"publisher","unstructured":"Myers JN, Greenberg JS, Mo V et al (2001) Extracapsular spread. A significant predictor of treatment failure in patients with squamous cell carcinoma of the tongue. Cancer 92:3030\u20133036. https:\/\/doi.org\/10.1002\/1097-0142(20011215)92:12%3C;3030::AID-CNCR10148%3E;3.0.CO;2-P","DOI":"10.1002\/1097-0142(20011215)92:12%3C;3030::AID-CNCR10148%3E;3.0.CO;2-P"},{"key":"9546_CR2","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/S0194-59989670285-1","volume":"114","author":"A Alvi","year":"1996","unstructured":"Alvi A, Johnson JT (1996) Extracapsular spread in the clinically negative neck (N0): implications and outcome. Otolaryngol Head Neck Surg 114:65\u201370. https:\/\/doi.org\/10.1016\/S0194-59989670285-1","journal-title":"Otolaryngol Head Neck Surg"},{"key":"9546_CR3","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.1056\/NEJMoa032641","volume":"350","author":"J Bernier","year":"2004","unstructured":"Bernier J, Domenge C, Ozsahin M et al (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:1945\u20131952","journal-title":"N Engl J Med"},{"key":"9546_CR4","doi-asserted-by":"publisher","first-page":"1937","DOI":"10.1056\/NEJMoa032646","volume":"350","author":"JS Cooper","year":"2004","unstructured":"Cooper JS, Pajak TF, Forastiere AA et al (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous\u3000cell carcinoma of the head and neck. N Engl J Med 350:1937\u20131944","journal-title":"N Engl J Med"},{"key":"9546_CR5","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1002\/hed.20279","volume":"27 9501","author":"J Bernier","year":"2005","unstructured":"Bernier J, Cooper JS, Pajak TF et al (2005) Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (22931) and RTOG. Head Neck 27 9501:843\u2013850. https:\/\/doi.org\/10.1002\/hed.20279","journal-title":"Head Neck"},{"key":"9546_CR6","doi-asserted-by":"publisher","first-page":"122","DOI":"10.3322\/caac.21389","volume":"67","author":"WM Lydiatt","year":"2017","unstructured":"Lydiatt WM, Patel SG, O\u2019Sullivan B et al (2017) Head and neck cancers-major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin 67:122\u2013137. https:\/\/doi.org\/10.3322\/caac.21389","journal-title":"CA Cancer J Clin"},{"key":"9546_CR7","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.oraloncology.2018.04.015","volume":"81","author":"MD Mair","year":"2018","unstructured":"Mair MD, Shetty R, Nair D et al (2018) Depth of invasion, size and number of metastatic nodes predicts extracapsular spread in early oral cancers with occult metastases. Oral Oncol 81:95\u201399. https:\/\/doi.org\/10.1016\/j.oraloncology.2018.04.015","journal-title":"Oral Oncol"},{"issue":"Suppl 1","key":"9546_CR8","doi-asserted-by":"publisher","first-page":"E1192","DOI":"10.1002\/hed.24190","volume":"38","author":"VB Wreesman","year":"2016","unstructured":"Wreesman VB, Katabi N, Palmer FL et al (2016) Influence of extracapsular nodal spread extent on prognosis of oral squamous cell carcinoma. Head Neck 38(Suppl 1):E1192\u2013E1199. https:\/\/doi.org\/10.1002\/hed.24190","journal-title":"Head Neck"},{"key":"9546_CR9","doi-asserted-by":"publisher","first-page":"104845","DOI":"10.1016\/j.oraloncology.2020.104845","volume":"110","author":"JR de Almeida","year":"2020","unstructured":"de Almeida JR, Truong T, Khan NM et al (2020) Treatment implications of postoperative chemoradiotherapy for squamous cell carcinoma of the oral cavity with minor and major extranodal extension. Oral Oncol 110:104845. https:\/\/doi.org\/10.1016\/j.oraloncology.2020.104845","journal-title":"Oral Oncol"},{"key":"9546_CR10","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1038\/modpathol.2011.105","volume":"24","author":"JS Lewis Jr","year":"2011","unstructured":"Lewis JS Jr, Carpenter DH, Thorstad WL et al (2011) Extracapsular extension is a poor predictor of disease recurrence in surgically treated oropharyngeal squamous cell carcinoma. Mod Pathol 24:1413\u20131420. https:\/\/doi.org\/10.1038\/modpathol.2011.105","journal-title":"Mod Pathol"},{"key":"9546_CR11","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1002\/lary.27508","volume":"129","author":"JP Agarwal","year":"2019","unstructured":"Agarwal JP, Kane S, Ghosh-Laskar S et al (2019) Extranodal extension in resected oral cavity squamous cell carcinoma: more to it than Meets the eye. Laryngoscope 129:1130\u20131136. https:\/\/doi.org\/10.1002\/lary.27508","journal-title":"Laryngoscope"},{"key":"9546_CR12","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1016\/j.ijom.2020.07.006","volume":"50","author":"M Mamic","year":"2021","unstructured":"Mamic M, Lucijanic M, Manojlovic L et al (2021) Prognostic significance of extranodal extension in oral cavity squamous cell carcinoma with occult neck metastases. Int J Oral Maxillofac Surg 50:309\u2013315. https:\/\/doi.org\/10.1016\/j.ijom.2020.07.006","journal-title":"Int J Oral Maxillofac Surg"},{"key":"9546_CR13","doi-asserted-by":"publisher","first-page":"103511","DOI":"10.1016\/j.amjoto.2022.103511","volume":"43","author":"BA Quinton","year":"2022","unstructured":"Quinton BA, Cabrera CI, Tamaki A et al (2022) The impact of microscopic versus macroscopic extranodal extension in oral cavity squamous cell carcinoma: National cancer database analysis and review of the literature. Am J Otolaryngol 43:103511. https:\/\/doi.org\/10.1016\/j.amjoto.2022.103511","journal-title":"Am J Otolaryngol"},{"key":"9546_CR14","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1002\/lary.30158","volume":"133","author":"K Joshi","year":"2023","unstructured":"Joshi K, Agarwal M, Pasricha S et al (2023) Macroscopic extranodal extension in oral squamous cell carcinoma-a subgroup with poor survival. Laryngoscope 133:588\u2013593. https:\/\/doi.org\/10.1002\/lary.30158","journal-title":"Laryngoscope"},{"key":"9546_CR15","doi-asserted-by":"publisher","first-page":"1464","DOI":"10.1002\/cncr.11202","volume":"97","author":"JS Greenberg","year":"2003","unstructured":"Greenberg JS, Fowler R, Gomez J et al (2003) Extent of extracapsular spread: a critical prognosticator in oral tongue cancer. Cancer 97:1464\u20131470. https:\/\/doi.org\/10.1002\/cncr.11202","journal-title":"Cancer"},{"key":"9546_CR16","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/S1368-8375(02)00030-1","volume":"39","author":"JA Woolgar","year":"2003","unstructured":"Woolgar JA, Rogers SN, Lowe D et al (2003) Cervical lymph node metastasis in oral cancer: the importance of even microscopic extracapsular spread. Oral Oncol 39:130\u2013137. https:\/\/doi.org\/10.1016\/S1368-8375(02)00030-1","journal-title":"Oral Oncol"},{"key":"9546_CR17","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1016\/j.bjoms.2020.09.015","volume":"59","author":"G Tirelli","year":"2021","unstructured":"Tirelli G, Tofanelli M, Sacchet E et al (2021) Extranodal extension in head and neck squamous cell cancer: is there a role for further stratification? Br J Oral Maxillofac Surg 59:567\u2013572. https:\/\/doi.org\/10.1016\/j.bjoms.2020.09.015","journal-title":"Br J Oral Maxillofac Surg"},{"key":"9546_CR18","doi-asserted-by":"publisher","first-page":"1978","DOI":"10.1016\/j.joms.2022.08.019","volume":"80","author":"DL Best","year":"2022","unstructured":"Best DL, Jazayeri HE, McHugh JB et al (2022) Extent of extranodal extension in oral cavity squamous cell carcinoma is not independently associated with overall or Disease-Free survival at a 2.0-mm threshold. J Oral Maxillofac Surg 80:1978\u20131988. https:\/\/doi.org\/10.1016\/j.joms.2022.08.019Epub 2022 Sep 2","journal-title":"J Oral Maxillofac Surg"},{"key":"9546_CR19","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1093\/jjco\/hyx055","volume":"47","author":"F Matsumoto","year":"2017","unstructured":"Matsumoto F, Mori T, Matsumura S et al (2017) Prognostic significance of surgical extranodal extension in head and neck squamous cell carcinoma patients. Jpn J Clin Oncol 47:699\u2013704. https:\/\/doi.org\/10.1093\/jjco\/hyx055","journal-title":"Jpn J Clin Oncol"},{"key":"9546_CR20","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1002\/hed.21244","volume":"32","author":"RJ Shaw","year":"2010","unstructured":"Shaw RJ, Lowe D, Woolgar JA et al (2010) Extracapsular spread in oral squamous cell carcinoma. Head Neck 32:714\u2013722. https:\/\/doi.org\/10.1002\/hed.21244","journal-title":"Head Neck"},{"key":"9546_CR21","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1016\/S1368-8375(02)00052-0","volume":"38","author":"A Ferlito","year":"2002","unstructured":"Ferlito A, Rinaldo A, Devaney KO et al (2002) Prognostic significance of microscopic and macroscopic extracapsular spread from metastatic tumor in the cervical lymph nodes. Oral Oncol 38:747\u2013751. https:\/\/doi.org\/10.1016\/S1368-8375(02)00052-0","journal-title":"Oral Oncol"},{"key":"9546_CR22","doi-asserted-by":"publisher","first-page":"1499","DOI":"10.1002\/cncr.28596","volume":"120","author":"RS Prabhu","year":"2014","unstructured":"Prabhu RS, Hanasoge S, Magliocca KR et al (2014) Extent of pathologic extracapsular extension and outcomes in patients with nonoropharyngeal head and neck cancer treated with initial surgical resection. Cancer 120:1499\u20131506. https:\/\/doi.org\/10.1002\/cncr.28596","journal-title":"Cancer"},{"key":"9546_CR23","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1002\/(SICI)1097-0347(199801)20:1<16::AID-HED3>3.0.CO;2-6","volume":"20","author":"M Brasilino de Carvalho","year":"1998","unstructured":"Brasilino de Carvalho M (1998) Quantitative analysis of the extent of extracapsular invasion and its prognostic significance: a prospective study of 170 cases of carcinoma of the larynx and hypopharynx. Head Neck 20:16\u201321. https:\/\/doi.org\/10.1002\/(SICI)1097-0347(199801)20:1%3C;16::AID-HED3%3E;3.0.CO;2-6","journal-title":"Head Neck"},{"key":"9546_CR24","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1002\/hed.21823","volume":"34","author":"MW van den Brekel","year":"2012","unstructured":"van den Brekel MW, Lodder WL, Stel HV et al (2012) Observer variation in the histopathologic assessment of extranodal tumor spread in lymph node metastases in the neck. Head Neck 34:840\u2013845. https:\/\/doi.org\/10.1002\/hed.21823","journal-title":"Head Neck"},{"key":"9546_CR25","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1016\/j.oraloncology.2015.08.003","volume":"51","author":"JS Lewis Jr","year":"2015","unstructured":"Lewis JS Jr, Tarabishy Y, Luo J et al (2015) Inter- and intra-observer variability in the classification of extracapsular extension in p16 positive oropharyngeal squamous cell carcinoma nodal metastases. Oral Oncol 51:985\u2013990. https:\/\/doi.org\/10.1016\/j.oraloncology.2015.08.003","journal-title":"Oral Oncol"},{"key":"9546_CR26","doi-asserted-by":"publisher","first-page":"3601","DOI":"10.1200\/JCO.2016.71.1176","volume":"35","author":"AS Ho","year":"2017","unstructured":"Ho AS, Kim S, Tighiouart M et al (2017) Metastatic lymph node burden and survival in oral cavity cancer. J Clin Oncol 35:3601\u20133609. https:\/\/doi.org\/10.1200\/JCO.2016.71.1176","journal-title":"J Clin Oncol"},{"key":"9546_CR27","doi-asserted-by":"publisher","unstructured":"Roberts TJ, Colevas AD, Hara W et al (2016) Number of positive nodes is superior to the lymph node ratio and American joint committee on cancer N staging for the prognosis of surgically treated head and neck squamous cell carcinomas. Cancer 122:1388\u20131397.\u00a0https:\/\/doi.org\/10.1002\/cncr.29932","DOI":"10.1002\/cncr.29932"}],"container-title":["European Archives of Oto-Rhino-Laryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-025-09546-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00405-025-09546-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-025-09546-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T18:59:00Z","timestamp":1760381940000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00405-025-09546-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,4]]},"references-count":27,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["9546"],"URL":"https:\/\/doi.org\/10.1007\/s00405-025-09546-y","relation":{},"ISSN":["0937-4477","1434-4726"],"issn-type":[{"value":"0937-4477","type":"print"},{"value":"1434-4726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,4]]},"assertion":[{"value":"21 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}