CT-Based Extranodal Extension Fails to Stratify Survival in HPV-Positive Head and Neck Cancer

Pre-treatment CT-based extranodal extension (iENE) did not predict recurrence-free survival in HPV-associated head and neck cancer. Gene signatures of inflammation captured prognostic information, suggesting tumor inflammation confounds iENE assessment (p<0.0001).

• Imaging-determined ENE (iENE) on CT did not significantly stratify recurrence-free survival in patients with HPV-associated HNSCC.
• Machine learning-derived signatures for ENE and inflammatory signaling were each associated with better recurrence-free survival (p<0.01 and p<0.0001), and within those strata, iENE added no further prognostic value.
• Stratified analyses were exploratory and limited by small subgroup size; the findings suggest an inflamed tumor microenvironment may confound radiographic ENE determination.

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