Prognostic value of clinical and radiologic extranodal extension and their role in the 8th edition TNM cN classification for HPV-negative oropharyngeal carcinoma. (March 2021)

• Record Type: Journal Article
• Authors: Pilar, Avinash; Yu, Eugene; Su, Jie; O'Sullivan, Brian; Bartlett, Eric; Waldron, John N.; Ringash, Jolie; Spreafico, Anna; Hansen, Aaron R.; de Almeida, John; Bayley, Andrew; Bratman, Scott V.; Cho, John; Giuliani, Meredith; Hope, Andrew; Hosni, Ali; Kim, John; Tong, Li; Xu, Wei; Huang, Shao Hui
• Is Part Of: Oral oncology. Volume 114(2021)
• Publication Date: 2021-03
• Subjects: Human papillomavirus negative -- Oropharyngeal carcinoma -- Radiology -- Extranodal extension -- Prognosis -- Staging; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2020.105167
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: ENE can be reliably ascertained by clinical examination and radiology assessment. rENE confirmation enhances objectivity of cENE affirmation. cENE and rENE are both prognostic for HPV-negative oropharyngeal cancer. The TNM-8N-category with inclusion of cENE improves outcome prediction vs TNM-7. Incorporating rENE into TNM-8 may further augment the performance. Abstract: Background/objectives: We evaluate the performance between the TNM-8 versus TNM-7 cN-classification and explore the relative prognostic contribution of radiologic extranodal extension (rENE) for HPV-negative oropharyngeal cancer (HPV–OPC). Materials/methods: All HPV– OPC treated with IMRT between 2005 and 2016 were included. cENE was defined as unambiguous "fixation" of a neck mass or "skin involvement" on clinical examination. rENE was recorded by re-reviewing pre-treatment CT/MR. Disease-free survival (DFS) stratified by cENE or rENE were compared. Multivariable analyses (MVA) calculated the adjusted hazard ratio (aHR) for the separate cENE and rENE attributes and their combination. A refined cN-category incorporating both cENE and rENE parameters was proposed. The performance of the revision was compared to TNM-8 and TNM-7. Results: Of 361 HPV– OPC, 97 were cN0 and 264 were cN+ with 48 cENE+ and 72 rENE+ respectively. Median follow-up was 5.4 years. The 3-year DFS was lower in cENE+ vs cENE-negative (cENE–) (23% vs 45%; aHR = 1.68, p = 0.008) and rENE+ vs rENE-negative (rENE–) patients (29% vs 45%; aHR = 1.44, p = 0.037). The cENE+/rENE+ subset had the worse DFS vs cENE–/rENE+ or cENE–/rENE– (24%/37%/46%, p = 0.005). We propose a refined cN-category wherein any cENE–/rENE+ case is reclassified one N-stratum higher while any cENE+ case remains cN3b. The stage schema with the refined N-categorization outperformed TNM-8, and both outperformed TNM-7. Conclusions: cENE and rENE are both prognostic but the cENE+/rENE+ subset has the worst outcome. The TNM-8 cN-categories improves outcome prediction compared to the TNM-7. Incorporation of rENE into TNM-8 cN-categories may further augment performance.