Top Line: The ninth edition of the TNM staging system for HPV+ oropharyngeal squamous cell carcinoma (oSCC) reclassifies patients with extranodal extension on imaging (iENE) to one stratum higher in the cN classification.
The Study: A secondary analysis of RTOG 1016 reviewed CT simulation scans from 586 patients with clinically node-positive p16+ OSCC treated with definitive radiation. Two expert head & neck radiologists retrospectively identified iENE in 350 patients (60%). As expected, patients with iENE had worse 5-year overall (79% vs 87%) and progression-free (69% vs 80%) survival, with iENE remaining independently associated with inferior OS (HR 1.63) and PFS (HR 1.78) on multivariable analysis. The authors then put the new TNM9 nodal schema—where iENE bumps patients up one nodal stage—head-to-head with TNM8. Indeed, TNM9 showed better separation of survival across nodal categories.
TBL: “We found that TNM9 clinical nodal schema outperformed clinical TNM8 in terms of clear separation of survival curves…confirming the decision to incorporate iENE into clinical nodal categories for TNM9.” | Fleming, JAMA Otolaryngol Head Neck Surg 2026
The Study: A secondary analysis of RTOG 1016 reviewed CT simulation scans from 586 patients with clinically node-positive p16+ OSCC treated with definitive radiation. Two expert head & neck radiologists retrospectively identified iENE in 350 patients (60%). As expected, patients with iENE had worse 5-year overall (79% vs 87%) and progression-free (69% vs 80%) survival, with iENE remaining independently associated with inferior OS (HR 1.63) and PFS (HR 1.78) on multivariable analysis. The authors then put the new TNM9 nodal schema—where iENE bumps patients up one nodal stage—head-to-head with TNM8. Indeed, TNM9 showed better separation of survival across nodal categories.
TBL: “We found that TNM9 clinical nodal schema outperformed clinical TNM8 in terms of clear separation of survival curves…confirming the decision to incorporate iENE into clinical nodal categories for TNM9.” | Fleming, JAMA Otolaryngol Head Neck Surg 2026