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A New Staging System for HPV-Related Oropharynx Cancer: Rationale, Derivation, Validation and Practical Applications

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Critical Issues in Head and Neck Oncology

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Abstract

The TNM classification plays a pivotal role in clinical care (predicting prognosis, patient communication, guiding treatment decision-making), research (clinical trial design, translational research), and cancer control (time trends and surveillance) activities. The recognition that HPV-mediated (HPV+) oropharyngeal cancer (OPC) is a new disease entity, and that the TNM-7th is inadequate in depicting prognosis, required the development of a novel staging system for HPV+ OPC and unknown primary with cervical nodal metastasis (CUP). The new classification, introduced by the Union for International Cancer Control and the American Joint Committee on Cancer (AJCC) in the 8th edition TNM, uses different definitions for clinical and pathological N categories and stage groupings. The latter reflects an increasing use of minimally invasive surgery for a subset of HPV+ OPC. The clinical TNM is applicable to all cases at initial diagnosis while the pathologic TNM is applicable to cases undergoing primary surgery with neck dissection. This is the first time in head and neck cancer where T4 or N3 disease without distant metastasis (M0) will not be classified as stage IV in the TNM. The clinical rationale, derivation, validation, and practical application of the new TNM classification for HPV+ OPC are summarized.

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Acknowledgement

We acknowledge the Sanming Project of Medicine in Shenzhen Fund (SZSM201612024) for supporting the authors’ (SHH, ZJC, and BOS) academic activities. We also acknowledge the O. Harold Warwick Prize of the Canadian Cancer Society for supporting the author’s (BOS) academic activities.

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Authors and Affiliations

  1. Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada

    Shao Hui Huang & Brian O’Sullivan

  2. Department of Clinical Oncology, The University of Hong Kong—Shenzhen Hospital, Shenzhen, China

    Zhi-Jian Chen & Brian O’Sullivan

Authors
  1. Shao Hui Huang
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  2. Zhi-Jian Chen
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  3. Brian O’Sullivan
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Corresponding author

Correspondence to Brian O’Sullivan .

Editor information

Editors and Affiliations

  1. Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium

    Jan B. Vermorken

  2. Department of Radiation Oncology, Charité University Medicine, Berlin, Germany

    Volker Budach

  3. Department of Otolaryngology , VU University Medical Center, Amsterdam, The Netherlands

    C. René Leemans

  4. Institut Roi Albert II, Université Catholique de Louvain , Louvain-la-Neuve, Belgium

    Jean-Pascal Machiels

  5. Department of Otorhinolarynology, University of Brescia, Brescia, Italy

    Piero Nicolai

  6. Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada

    Brian O'Sullivan

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Huang, S.H., Chen, ZJ., O’Sullivan, B. (2018). A New Staging System for HPV-Related Oropharynx Cancer: Rationale, Derivation, Validation and Practical Applications. In: Vermorken, J., Budach, V., Leemans, C., Machiels, JP., Nicolai, P., O'Sullivan, B. (eds) Critical Issues in Head and Neck Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-98854-2_11

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  • DOI: https://doi.org/10.1007/978-3-319-98854-2_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98853-5

  • Online ISBN: 978-3-319-98854-2

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