{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T14:27:41Z","timestamp":1794234461495,"version":"4.9.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82273097"],"award-info":[{"award-number":["82273097"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82203727"],"award-info":[{"award-number":["82203727"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Natural Science Foundation of Shanghai","award":["23ZR1409700"],"award-info":[{"award-number":["23ZR1409700"]}]},{"name":"Shanghai Municipal Key Clinical Specialty","award":["shslczdzk00801"],"award-info":[{"award-number":["shslczdzk00801"]}]},{"name":"Shanghai Sailing Program","award":["22YF1405700"],"award-info":[{"award-number":["22YF1405700"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Arch Otorhinolaryngol"],"published-print":{"date-parts":[[2026,10]]},"DOI":"10.1007\/s00405-026-10528-x","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T02:18:30Z","timestamp":1786328310000},"page":"7451-7460","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nodal fusion and soft tissue invasion provide incremental risk stratification in pathologically N3b classification hypopharyngeal squamous cell carcinoma"],"prefix":"10.1007","volume":"283","author":[{"given":"Feiran","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simin","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongli","family":"Gong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiying","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Tao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi-Yao","family":"Hsueh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2909-8446","authenticated-orcid":false,"given":"Ming","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"10528_CR1","doi-asserted-by":"crossref","unstructured":"Bray F, Laversanne M, sung H, et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin 74(3):229\u2013263","DOI":"10.3322\/caac.21834"},{"key":"10528_CR2","doi-asserted-by":"crossref","unstructured":"Garneau JC, Bakst RL, Miles BA (2018) Hypopharyngeal cancer: A state of the art review [J]. Oral Oncol 86:244\u2013250","DOI":"10.1016\/j.oraloncology.2018.09.025"},{"key":"10528_CR3","doi-asserted-by":"crossref","unstructured":"Meulemans J, Delaere P, Vander Poorten V (2019) Primary Treatment of T1-T2 Hypopharyngeal Cancer: Changing Paradigms [J]. Adv Otorhinolaryngol 83:54\u201365","DOI":"10.1159\/000492310"},{"key":"10528_CR4","doi-asserted-by":"crossref","unstructured":"Barroso Ribeiro R, Ribeiro Breda E, Fernandes Monteiro E (2012) Prognostic significance of nodal metastasis in advanced tumors of the larynx and hypopharynx [J]. Acta Otorrinolaringol Esp 63(4):292\u2013298","DOI":"10.1016\/j.otoeng.2012.07.014"},{"issue":"10","key":"10528_CR5","doi-asserted-by":"publisher","first-page":"1827","DOI":"10.1097\/00005537-200310000-00031","volume":"113","author":"MJ Veness","year":"2003","unstructured":"Veness MJ, Palme CE, Smith M et al (2003) Cutaneous head and neck squamous cell carcinoma metastatic to cervical lymph nodes (nonparotid): a better outcome with surgery and adjuvant radiotherapy. Laryngoscope 113(10):1827\u201333","journal-title":"Laryngoscope"},{"issue":"12","key":"10528_CR6","doi-asserted-by":"publisher","first-page":"1348","DOI":"10.1016\/j.ejso.2009.06.010","volume":"35","author":"X Li","year":"2009","unstructured":"Li X, Di B, Shang Y et al (2009) Clinicopathologic risk factors for distant metastases from head and neck squamous cell carcinomas. Eur J Surg Oncol 35(12):1348\u201353","journal-title":"Eur J Surg Oncol"},{"issue":"3","key":"10528_CR7","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1007\/s12105-009-0129-y","volume":"3","author":"RR Seethala","year":"2009","unstructured":"Seethala RR (2009) Current state of neck dissection in the United States. Head Neck Pathol 3(3):238\u201345","journal-title":"Head Neck Pathol"},{"key":"10528_CR8","doi-asserted-by":"crossref","unstructured":"Amin MB, GreenE FL, Edge SB et al (2017) The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more personalized approach to cancer staging [J]. CA Cancer J Clin 67(2):93\u201399","DOI":"10.3322\/caac.21388"},{"issue":"2","key":"10528_CR9","first-page":"122","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(2):122\u201337","journal-title":"CA Cancer J Clin"},{"key":"10528_CR10","doi-asserted-by":"crossref","unstructured":"Zanoni D K, Patel S G, Shah JP (2019) Changes in the 8th Edition of the American Joint Committee on Cancer (AJCC) Staging of Head and Neck Cancer: Rationale and Implications [J]. Curr Oncol Rep 21(6):52","DOI":"10.1007\/s11912-019-0799-x"},{"issue":"2","key":"10528_CR11","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.ijom.2015.09.005","volume":"45","author":"S Yamada","year":"2016","unstructured":"Yamada S, Yanamoto S, Otani S et al (2016) Evaluation of the level of progression of extracapsular spread for cervical lymph node metastasis in oral squamous cell carcinoma. Int J Oral Maxillofac Surg 45(2):141\u20136","journal-title":"Int J Oral Maxillofac Surg"},{"key":"10528_CR12","doi-asserted-by":"publisher","DOI":"10.1016\/j.prp.2025.156183","volume":"274","author":"S Chohan","year":"2025","unstructured":"Chohan S, Zaheer S (2025) Pathological extranodal extension in head and neck cancer: a prognostic biomarker with therapeutic ramifications and diagnostic pitfalls. Pathol Res Pract 274:156183","journal-title":"Pathol Res Pract"},{"issue":"3","key":"10528_CR13","doi-asserted-by":"publisher","first-page":"1311","DOI":"10.1007\/s00784-017-2231-y","volume":"22","author":"SI Yamada","year":"2018","unstructured":"Yamada SI, Otsuru M, Yanamoto S et al (2018) Progression level of extracapsular spread and tumor budding for cervical lymph node metastasis of OSCC. Clin Oral Investig 22(3):1311\u20138","journal-title":"Clin Oral Investig"},{"issue":"12","key":"10528_CR14","doi-asserted-by":"publisher","first-page":"1727","DOI":"10.1002\/hed.21997","volume":"34","author":"ME Spector","year":"2012","unstructured":"Spector ME, Gallagher KK, Light E et al (2012) Matted nodes: poor prognostic marker in oropharyngeal squamous cell carcinoma independent of HPV and EGFR status. Head Neck 34(12):1727\u201333","journal-title":"Head Neck"},{"key":"10528_CR15","doi-asserted-by":"crossref","unstructured":"Vainshtein JM, Spector ME, Ibrahim M et al (2016) Matted nodes: High distant-metastasis risk and a potential indication for intensification of systemic therapy in human papillomavirus-related oropharyngeal cancer [J]. Head Neck 38(Suppl 1):E805\u2013E814","DOI":"10.1002\/hed.24105"},{"issue":"6","key":"10528_CR16","doi-asserted-by":"publisher","first-page":"1976","DOI":"10.1002\/jmri.29012","volume":"59","author":"A Dong","year":"2024","unstructured":"Dong A, Zhu S, Ma H et al (2024) Matted lymph nodes on MRI in nasopharyngeal carcinoma: prognostic factor and potential indication for induction chemotherapy benefits. J Magn Reson Imaging 59(6):1976\u201390","journal-title":"J Magn Reson Imaging"},{"issue":"2","key":"10528_CR17","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1002\/hed.23882","volume":"38","author":"ME Spector","year":"2016","unstructured":"Spector ME, Chinn SB, Bellile E et al (2016) Matted nodes as a predictor of distant metastasis in advanced-stage III\/IV oropharyngeal squamous cell carcinoma. Head Neck 38(2):184\u201390","journal-title":"Head Neck"},{"key":"10528_CR18","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.oraloncology.2016.10.003","volume":"62","author":"M Mermod","year":"2016","unstructured":"Mermod M, Tolstonog G, Simon C et al (2016) Extracapsular spread in head and neck squamous cell carcinoma: a systematic review and meta-analysis. Oral Oncol 62:60\u201371","journal-title":"Oral Oncol"},{"issue":"4","key":"10528_CR19","doi-asserted-by":"publisher","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(4):103511","journal-title":"Am J Otolaryngol"},{"key":"10528_CR20","doi-asserted-by":"crossref","unstructured":"Wreesmann VB, Katabi N, Palmer FL, et al (2016) Influence of extracapsular nodal spread extent on prognosis of oral squamous cell carcinoma [J]. Head Neck 38(Suppl 1Suppl 1):E1192\u2013E1199","DOI":"10.1002\/hed.24190"},{"issue":"3","key":"10528_CR21","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(3):309\u201315","journal-title":"Int J Oral Maxillofac Surg"},{"issue":"3","key":"10528_CR22","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(3):588\u201393","journal-title":"Laryngoscope"},{"issue":"6","key":"10528_CR23","doi-asserted-by":"publisher","first-page":"1769","DOI":"10.1002\/hed.28090","volume":"47","author":"N Kijima","year":"2025","unstructured":"Kijima N, Uzawa Y, Hirai Y et al (2025) Clinicopathological significance of extranodal extension in hypopharyngeal and laryngeal squamous cell carcinoma. Head Neck 47(6):1769\u201378","journal-title":"Head Neck"},{"issue":"2","key":"10528_CR24","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/j.ejso.2019.09.005","volume":"46","author":"Y Heng","year":"2020","unstructured":"Heng Y, Zhu X, Zhou L et al (2020) A prognostic nomogram for predicting the long-term survival outcome of hypopharyngeal squamous cell carcinoma patients after tumour resection to assist the decision-making of postoperative adjuvant treatment. Eur J Surg Oncol 46(2):245\u201351","journal-title":"Eur J Surg Oncol"},{"issue":"8","key":"10528_CR25","doi-asserted-by":"publisher","first-page":"1535","DOI":"10.1002\/hed.24705","volume":"39","author":"Y Saito","year":"2017","unstructured":"Saito Y, Omura G, Yasuhara K et al (2017) Prognostic value of lymphovascular invasion of the primary tumor in hypopharyngeal carcinoma after total laryngopharyngectomy. Head Neck 39(8):1535\u201343","journal-title":"Head Neck"},{"issue":"5","key":"10528_CR26","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1002\/ohn.187","volume":"168","author":"F Li","year":"2023","unstructured":"Li F, Huang Q, Hsueh C et al (2023) A survival nomogram containing lymph node ratio for hypopharyngeal carcinoma patients after neck dissection. Otolaryngol Head Neck Surg 168(5):1097\u2013106","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"4","key":"10528_CR27","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1002\/lary.30241","volume":"133","author":"F Li","year":"2023","unstructured":"Li F, Hsueh C, Huang H et al (2023) A nomogram to predict nodal response after induction chemotherapy for hypopharyngeal carcinoma. Laryngoscope 133(4):849\u201355","journal-title":"Laryngoscope"},{"issue":"1","key":"10528_CR28","doi-asserted-by":"publisher","first-page":"1466","DOI":"10.1038\/s41467-023-37159-8","volume":"14","author":"Y ZHANG","year":"2023","unstructured":"ZHANG Y, LIU G, TAO M et al (2023) Integrated transcriptome study of the tumor microenvironment for treatment response prediction in male predominant hypopharyngeal carcinoma [J]. Nat Commun 14(1):1466","journal-title":"Nat Commun"},{"key":"10528_CR29","doi-asserted-by":"publisher","DOI":"10.3390\/antiox11010145","author":"G Ferraguti","year":"2022","unstructured":"Ferraguti G, Terracina S, Petrella C et al (2022) Alcohol and head and neck cancer: updates on the role of oxidative stress, genetic, epigenetics, oral microbiota, antioxidants, and alkylating agents. Antioxidants (Basel). https:\/\/doi.org\/10.3390\/antiox11010145","journal-title":"Antioxidants (Basel)"}],"container-title":["European Archives of Oto-Rhino-Laryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-026-10528-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00405-026-10528-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-026-10528-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T14:04:13Z","timestamp":1794233053000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00405-026-10528-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":29,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10528"],"URL":"https:\/\/doi.org\/10.1007\/s00405-026-10528-x","relation":{},"ISSN":["0937-4477","1434-4726"],"issn-type":[{"value":"0937-4477","type":"print"},{"value":"1434-4726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]},"assertion":[{"value":"22 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors have no conflicts of interest to disclose.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}