HPV and Oropharyngeal Cancer in the Eighth Edition of the TNM Classification: Pitfalls in Practice
This review is a call for mindfulness and precision when applying TNM 8 in oropharyngeal cancers. Implications, intentions, and weaknesses of TNM 8 are addressed in light of our own investigations and the published literature. In TNM 8, the impact of p16INK4A status on the staging of oropharyngeal S...
Main Authors: | , |
---|---|
Format: | Article |
Language: | English |
Published: |
Elsevier
2019-08-01
|
Series: | Translational Oncology |
Online Access: | http://www.sciencedirect.com/science/article/pii/S1936523319302256 |
id |
doaj-cdc665528a0e498ba027b24745c4849f |
---|---|
record_format |
Article |
spelling |
doaj-cdc665528a0e498ba027b24745c4849f2020-11-24T21:24:04ZengElsevierTranslational Oncology1936-52332019-08-0112811081112HPV and Oropharyngeal Cancer in the Eighth Edition of the TNM Classification: Pitfalls in PracticeMarkus Hoffmann0Silke Tribius1Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts University Kiel, Kiel, Germany; Address all correspondence to: Markus Hoffmann, Christian-Albrechts-University Kiel, Department of Otorhinolaryngology, Head and Neck Surgery, Arnold-Heller-Str. 3, Building 27, D24105 Kiel, Germany.Hermann-Holthusen-Institute for Radiation Oncology, Asklepios Hospital St. Georg, Hamburg, GermanyThis review is a call for mindfulness and precision when applying TNM 8 in oropharyngeal cancers. Implications, intentions, and weaknesses of TNM 8 are addressed in light of our own investigations and the published literature. In TNM 8, the impact of p16INK4A status on the staging of oropharyngeal SCC highlights i) that underlying evidence is scarce, ii) its stage grouping exclusively has prognostic intention, and iii) that a noncritical application of TNM 8 might negatively impact the patients' survival as the perception of TNM 8 as having therapeutic intention may lead to de-escalating treatment regimens in p16INK4A-positive cases, specifically when grouped into stage I despite the presence of neck metastasis. If other parameters from HPV positivity that also have a negative impact on the patient's survival, such as smoking or the presence of comorbidity, are neglected in therapy planning, survival outcomes might even become worse. Future studies applying TNM 8 and further investigating the value of p16INK4A as surrogate marker for active HPV infections will identify whether or not changes in TNM 8 should have therapeutic implications in HPV-associated, only p16INK4A-positive cases or whether this impact additionally holds true for nontonsillar cancers.http://www.sciencedirect.com/science/article/pii/S1936523319302256 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Markus Hoffmann Silke Tribius |
spellingShingle |
Markus Hoffmann Silke Tribius HPV and Oropharyngeal Cancer in the Eighth Edition of the TNM Classification: Pitfalls in Practice Translational Oncology |
author_facet |
Markus Hoffmann Silke Tribius |
author_sort |
Markus Hoffmann |
title |
HPV and Oropharyngeal Cancer in the Eighth Edition of the TNM Classification: Pitfalls in Practice |
title_short |
HPV and Oropharyngeal Cancer in the Eighth Edition of the TNM Classification: Pitfalls in Practice |
title_full |
HPV and Oropharyngeal Cancer in the Eighth Edition of the TNM Classification: Pitfalls in Practice |
title_fullStr |
HPV and Oropharyngeal Cancer in the Eighth Edition of the TNM Classification: Pitfalls in Practice |
title_full_unstemmed |
HPV and Oropharyngeal Cancer in the Eighth Edition of the TNM Classification: Pitfalls in Practice |
title_sort |
hpv and oropharyngeal cancer in the eighth edition of the tnm classification: pitfalls in practice |
publisher |
Elsevier |
series |
Translational Oncology |
issn |
1936-5233 |
publishDate |
2019-08-01 |
description |
This review is a call for mindfulness and precision when applying TNM 8 in oropharyngeal cancers. Implications, intentions, and weaknesses of TNM 8 are addressed in light of our own investigations and the published literature. In TNM 8, the impact of p16INK4A status on the staging of oropharyngeal SCC highlights i) that underlying evidence is scarce, ii) its stage grouping exclusively has prognostic intention, and iii) that a noncritical application of TNM 8 might negatively impact the patients' survival as the perception of TNM 8 as having therapeutic intention may lead to de-escalating treatment regimens in p16INK4A-positive cases, specifically when grouped into stage I despite the presence of neck metastasis. If other parameters from HPV positivity that also have a negative impact on the patient's survival, such as smoking or the presence of comorbidity, are neglected in therapy planning, survival outcomes might even become worse. Future studies applying TNM 8 and further investigating the value of p16INK4A as surrogate marker for active HPV infections will identify whether or not changes in TNM 8 should have therapeutic implications in HPV-associated, only p16INK4A-positive cases or whether this impact additionally holds true for nontonsillar cancers. |
url |
http://www.sciencedirect.com/science/article/pii/S1936523319302256 |
work_keys_str_mv |
AT markushoffmann hpvandoropharyngealcancerintheeightheditionofthetnmclassificationpitfallsinpractice AT silketribius hpvandoropharyngealcancerintheeightheditionofthetnmclassificationpitfallsinpractice |
_version_ |
1725989774391508992 |