Here is a much-needed proposed staging update for salivary gland carcinomas based on NCDB data and external validation cohorts. As it stands, survival curves for N2a, N2b, and N2c largely overlapped, with N2c-N3 comprising <1% of cases. Simplified nodal staging cleanly separated survival outcomes. When N1 is defined as 1–3 involved nodes with no extranodal extension (ENE) and N2 as >3 involved nodes or any ENE, five-year survival was: 87% (N0), 66% (N1), 43% (N2). Of note, ENE is all or nothing as there was no meaningful difference in outcomes between “minor” (≤2 mm) and “major” extent. They also suggest the commonsense strategy of reserving stage IV exclusively for M1, mirroring HPV+ OPC and nasopharynx schemas. Finally, they propose “a more intuitive approach that consolidates minor and major salivary gland carcinoma into a single staging schema,” rather than the current approach of lumping minor salivary gland tumors in with mucosal SCC staging based on anatomic location. | Huang, JAMA Otolaryngol Head Neck Surg 2026
