Top Line: Efforts continue to discern which HPV+ oropharyngeal squamous cell carcinomas (oSCC) stand to benefit from more intensive therapy.
The Study: Despite generally carrying a better prognosis than HPV- counterparts, features such as overall disease volume and extranodal extension still matter despite 8th edition staging suggesting otherwise. As it stands now, over half of patients with HPV+ oSCC are lumped together as stage one regardless of the extent of ipsilateral disease so long as no single node is >6 cm. Here, a large multi-institutional retrospective cohort study of over 2K patients receiving definitive treatment for oSCC aims to refine staging such that it better predicts outcomes. Ultimately the presence of radiographic extranodal extension, as seen in 710/1898 cases (37.4%) of nodal disease, was the single biggest nodal predictor of outcomes: 5-year overall survival was 71% with ENE v 87% without (AHR 2.32) and disease-free survival was 63% v 83% (AHR 2.46). A simple reclassification of a stepwise increase in N-staging for nodal disease with radiographic ENE outperformed the current TNM staging system in predicting both overall and disease-free survival.
TBL:“For the ninth edition of the TNM staging system, we propose a modification that reclassifies patients with imaging ENE to 1 stratum higher in the cN classification.” | Yin, JAMA Otolaryngol Head Neck Surg 2025
The Study: Despite generally carrying a better prognosis than HPV- counterparts, features such as overall disease volume and extranodal extension still matter despite 8th edition staging suggesting otherwise. As it stands now, over half of patients with HPV+ oSCC are lumped together as stage one regardless of the extent of ipsilateral disease so long as no single node is >6 cm. Here, a large multi-institutional retrospective cohort study of over 2K patients receiving definitive treatment for oSCC aims to refine staging such that it better predicts outcomes. Ultimately the presence of radiographic extranodal extension, as seen in 710/1898 cases (37.4%) of nodal disease, was the single biggest nodal predictor of outcomes: 5-year overall survival was 71% with ENE v 87% without (AHR 2.32) and disease-free survival was 63% v 83% (AHR 2.46). A simple reclassification of a stepwise increase in N-staging for nodal disease with radiographic ENE outperformed the current TNM staging system in predicting both overall and disease-free survival.
TBL:“For the ninth edition of the TNM staging system, we propose a modification that reclassifies patients with imaging ENE to 1 stratum higher in the cN classification.” | Yin, JAMA Otolaryngol Head Neck Surg 2025