临床结外延伸 (cENE) 是喉下咽癌 (LHC) TNM-8 中的 cN 修饰符。我们假设图像检测 ENE (iENE) 可以在 LHC 中提供比 cENE 更高的预后价值。神经放射科医生使用国际公认的标准对 2010 年至 2019 年间接受根治性（化疗）放疗的 cN LHC 患者的基线 CT/MRI 进行了重新审查iENE 阳性/阴性标准 (iENE /iENE-)。通过 iENE 状态比较总生存期 (OS)。进行多变量分析 (MVA) 以确认 iENE 的预后价值，并针对已知的潜在混杂因素进行调整。总共确定了 232 名 LHC 患者，包括 154 名 iENE-/cENE-、60 名 iENE /cENE- 和 18 名 iENE /cENE。 iENE（与 iENE-）患者相比，淋巴结 (LN) 大小 > 3 厘米的比例较高 [53 (67%) vs 4 (3%)]，≥5 个 LN [51 (65%) vs 33 (21%) )] 和咽后淋巴结 [12 (15%) vs 6 (4%)]（所有 p < 0.01）。中位随访时间为 4.8 年。 iENE /cENE- 和 iENE /cENE 患者的 5 年 OS 也同样较低 [28% (18-44) 和 29% (13-63)]，而 iENE-/cENE- [53% (45-62)] (p <0.001）。在 MVA 中，iENE 的死亡风险高于 iENE-[风险比 (HR) 2.22 (95% CI 1.47-3.36)]。 iENE 的预后价值在喉部 (n = 124) (HR 2.51 [1.35-4.68], p = 0.004] 或下咽部 (n = 108) (HR 1.87 [1.02-3.43], p = 0.04) 患者中仍具有 MVA，我们的研究证实了 iENE 对于 LHC 的独立预后重要性，除了 TNM-8 cN 状态（已经包含 cENE 参数）之外，还需要进一步研究来探索 iENE 是否可以取代 cENE 进行未来的 cN 分类。 © 2024 Elsevier Ltd. 保留所有权利。

Clinical extranodal extension (cENE) is a cN modifier in TNM-8 for laryngo-hypopharygeal carcinoma (LHC). We hypothesize that image-detected ENE (iENE) can provide additional prognostic value over cENE in LHC.Baseline CTs/MRIs of cN+ LHC patients treated with definitive (chemo-)radiotherapy between 2010-2019 were re-reviewed by a neuroradiologist using internationally accepted criteria for iENE-positive/negative (iENE+/iENE-). Overall survival (OS) was compared by iENE status. Multivariable analysis (MVA) was performed to confirm the prognostic value of iENE, adjusted for known potential confounders.A total of 232 LHC patients were identified, including 154 iENE-/cENE-, 60 iENE+/cENE-, and 18 iENE+/cENE+. A higher proportion of iENE+ (vs iENE-) patients had lymph node (LN) size > 3 cm [53 (67 %) vs 4 (3 %)], >=5 LNs [51 (65 %) vs 33 (21 %)], and retropharyngeal LN [12 (15 %) vs 6 (4 %)] (all p < 0.01). Median follow-up was 4.8 years. iENE+/cENE- and iENE+/cENE+patients had similarly low 5-year OS [28 % (18-44) and 29 % (13-63)] vs iENE-/cENE- [53 % (45-62)] (p < 0.001). On MVA, mortality risk was higher with iENE+vs iENE- [hazard ratio (HR) 2.22 (95 % CI 1.47-3.36)]. The prognostic value of iENE remained with MVA in larynx (n = 124) (HR 2.51 [1.35-4.68], p = 0.004] or hypopharynx (n = 108) (HR 1.87 [1.02-3.43], p = 0.04) patients, separately.Our study confirms the independent prognostic importance of iENE for LHC following definitive (chemo-)radiotherapy beyond TNM-8 cN status that already contains the cENE parameter. Further research is needed to explore whether iENE could replace cENE for future cN classification.Copyright © 2024 Elsevier Ltd. All rights reserved.