Otolaryngology (ENT)

ESS remains the cost-effective workhorse over biologics for most CRSwNP

This review compares outcomes and costs of biologics versus endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP). Phase 3 biologic trial results suggest symptom control comparable to ESS but at substantially higher cost to the healthcare system. Recent EPOS and AAO-HNS guidelines still prioritize ESS after failure of optimized medical therapy. Biologics are framed as an option mainly for severe, uncontrolled CRSwNP persisting despite comprehensive ESS. The authors call for long-term, head-to-head studies of biologics versus ESS to clarify durability and value. 1

Deep learning on CT outperforms experts for ENE detection in LHSCC

This multicenter study evaluated DeepENE, a CT-based deep learning tool, for detecting nodal metastasis and extranodal extension (ENE) in laryngeal and hypopharyngeal SCC. Among 289 patients with 1954 pathologically confirmed lymph nodes, DeepENE achieved ENE AUCs of 0.93 internally and 0.87–0.96 across external cohorts. DeepENE consistently outperformed five board-certified head and neck specialists, especially for early ENE, with markedly higher sensitivities at similar specificities. In one external set, it maintained 97% sensitivity at 90% specificity, versus 77% mean sensitivity for experts. These results suggest AI-assisted CT interpretation could improve preoperative staging and guide neck management and adjuvant therapy decisions. 2

Higher lymph node yield in neck dissection improves survival in advanced HNSCC

This single-center retrospective study analyzed 234 patients with advanced HNSCC undergoing curative neck dissection between 1997 and 2018. Above-average lymph node yield was associated with superior overall survival compared with average and especially below-average yields across bilateral, ipsilateral, and contralateral dissections. The survival benefit was particularly pronounced for contralateral dissections when more lymph nodes were removed. Multivariate Cox models supported lymph node yield as an independent prognostic factor. The findings support meticulous, comprehensive neck dissection and highlight lymph node yield as a potential quality metric. 3

p16+ OPC with high FOXP3/CD68 infiltration fares best with PD-1 blockade

This national DAHANCA cohort included 263 PD-L1–positive recurrent/metastatic HNSCC patients treated with pembrolizumab or nivolumab monotherapy. Pre-treatment biopsies were profiled for multiple immune markers, including CD4, CD8, FOXP3, CD68, and tumor-infiltrating lymphocytes. Concurrent above-median FOXP3 and CD68 expression was associated with substantially lower progression risk under PD-1 inhibition. In p16+ oropharyngeal cancer, this FOXP3high/CD68high subgroup had a 2-year PFS of 68%, versus 3% when one or both markers were low. PD-L1 expression alone did not correlate with outcomes, underscoring the value of composite immune microenvironment biomarkers. 4