Staging of oropharyngeal squamous cell carcinoma of the head and neck: Prognostic features and power of the 8th edition of the UICC staging manual

Beltz, Anna; Gößwein, Dorothee; Zimmer, S; Limburg, Ivonne; Wünsch, Desirée; Gribko, Alena; Deichelbohrer, Maximilian; Hagemann, Jan; Stauber, Roland H.; Künzel, Julian

doi:10.1016/j.ejso.2019.02.032

Cited by 23 publications

(28 citation statements)

References 27 publications

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“…Furthermore, An et al also demonstrated in the multivariate analysis that rather than the presence of ≥5 lymph node metastases-as integrated into the TNM classification for HPV-positive OPSCC-it is the presence of ENE that is significantly associated with a deterioration of overall survival (HR = 1.89; 95% CI = 1.01-3.51; p = 0.046) (37). Hence the results to some extent contradict the current system of N classification of p16-positive OPSCC (42).…”

Section: Extranodal Extension In the Context Of The 8th Uicc Classifimentioning

confidence: 75%

“…This is why the prognostic influence of ENE in HPV-induced tumors is currently the focus of a number of studies. In a 2019 study by the present authors, the application and prognostic impact of the new TNM classification as well as the factors HPV status and ENE were examined in a group of 255 patients with OPSCC first diagnosed in the years 2008-2015 (42). This included analyzing the overall survival of HPV-positive patients with negative vs. positive ENE status treated with surgery alone or surgery combined with adjuvant radiation/chemoradiation.…”

Section: Extranodal Extension In the Context Of The 8th Uicc Classifimentioning

confidence: 99%

“…In this cohort adjuvant therapy was standard in case of pathologically proven ENE. This study addressed, among other things, the question of whether ENE can actually be ignored in HPV-mediated OPSCC (42). Ninety five patients met the inclusion criteria for ENE analysis.…”

Section: Extranodal Extension In the Context Of The 8th Uicc Classifimentioning

confidence: 99%

“…For HPV-positive OPSCC patients who have undergone primary surgical treatment, it is only the absolute number of lymph nodes involved (cut-off between pN1 and pN2: ≥5 involved lymph nodes) which has the decisive prognostic influence on determining the pN category according to the 8th edition (42). Given comparable hazard ratios (≥5 lymph node metastases: HR = 1.81, p = 0.086 vs. ENE: HR = 1.89, p = 0.046), An et al do not question the cut-off of ≥5 lymph node metastases as a prognostic parameter for HPV-positive OPSCC.…”

Section: Extranodal Extension In the Context Of The 8th Uicc Classifimentioning

confidence: 99%

“…Prognostic influence of extranodal extension in patients with p16-positive oropharyngeal carcinoma (ENE, extranodal extension)(42).…”

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confidence: 99%

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Significance of Extranodal Extension in Surgically Treated HPV-Positive Oropharyngeal Carcinomas

et al. 2020

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Section: Extranodal Extension In the Context Of The 8th Uicc Classifimentioning

confidence: 75%

Section: Extranodal Extension In the Context Of The 8th Uicc Classifimentioning

confidence: 99%

Section: Extranodal Extension In the Context Of The 8th Uicc Classifimentioning

confidence: 99%

Section: Extranodal Extension In the Context Of The 8th Uicc Classifimentioning

confidence: 99%

“…Prognostic influence of extranodal extension in patients with p16-positive oropharyngeal carcinoma (ENE, extranodal extension)(42).…”

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confidence: 99%

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Significance of Extranodal Extension in Surgically Treated HPV-Positive Oropharyngeal Carcinomas

et al. 2020

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Improvement of patient stratification in human papilloma virus‐associated oropharyngeal squamous cell carcinoma by defining a multivariable risk score

et al. 2021

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Background: Precise risk stratification models are necessary to determine patient selection for deintensifying treatment trials in human papilloma virus (HPV)-associated oropharyngeal squamous cell cancer (HPV+ OPSCC).Methods: We examined 526 cases with OPSCC treated at our department between 2002 and 2017. Every patient was classified after the 7th and 8th edition UICC staging manual. For HPV+ OPSCC, we calculated a simple risk score with four risk groups based on multivariable Cox regression analysis of clinical and lifestyle parameters (UICC 8th edition stage, tobacco/alcohol abuse, age, gender).Results: Two hundred and thirty-nine patients with OPSCC (45.4%) showed a positive histological HPV status. In comparison to UICC 8th edition stages, our proposed risk model showed a tendency for better stratification between risk strata I/III, I/IV, and II/IV (each p < 0.002) and I/II, II/III, and III/IV (each p < 0.09). Conclusion:Age, gender, tobacco, and alcohol abuse should be added to the current UICC staging system in order to improve risk stratification in HPV+ OPSCC.

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Comparing adjuvant radiation to adjuvant chemoradiation in postsurgical p16+ oropharyngeal carcinoma patients with extranodal extension or positive margins

et al. 2021

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Background Adjuvant guidelines in surgically resected p16+ oropharyngeal carcinoma (OPC) with positive surgical margins (PSM) or extranodal extension (ENE) are based on randomized controlled trials predating p16 status. It remains unclear if adjuvant chemotherapy is necessary in p16+ patients with these features. Methods The National Cancer Database was used to identify cases of nonmetastatic p16+ OPC diagnosed from 2010 to 2017. Patients treated with surgical resection followed by adjuvant radiation (aRT) or adjuvant chemoradiation (aCRT) were eligible for analysis. Results A total of 14 071 patients were eligible for analysis. Overall survival (OS) was not statistically different between aRT and aCRT in patients with PSM (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.56–1.28), ENE (HR 0.93, 95% CI 0.69–1.27) or both (HR 0.73, 95% CI 0.41–1.31). Conclusions In patients with p16+ OPC with ENE, PSM, or both, adding chemotherapy to aRT was not associated with improved OS.

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Staging of oropharyngeal squamous cell carcinoma of the head and neck: Prognostic features and power of the 8th edition of the UICC staging manual

Cited by 23 publications

References 27 publications

Significance of Extranodal Extension in Surgically Treated HPV-Positive Oropharyngeal Carcinomas

Significance of Extranodal Extension in Surgically Treated HPV-Positive Oropharyngeal Carcinomas

Improvement of patient stratification in human papilloma virus‐associated oropharyngeal squamous cell carcinoma by defining a multivariable risk score

Comparing adjuvant radiation to adjuvant chemoradiation in postsurgical p16+ oropharyngeal carcinoma patients with extranodal extension or positive margins

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