Shao Hui Huang1, Brian O'Sullivan2, Jie Su3, Eric Bartlett4, John Kim5, John N Waldron2, Jolie Ringash5, John R de Almeida6, Scott Bratman5, Aaron Hansen7, Andrew Bayley5, John Cho5, Meredith Giuliani5, Andrew Hope5, Ali Hosni5, Anna Spreafico7, Lillian Siu7, Douglas Chepeha6, Lt Tong5, Wei Xu3, Eugene Yu4. 1. Department of Radiation Oncology, the Princess Margaret Cancer Centre/University of Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, the Princess Margaret Cancer Centre/University of Toronto, Canada. Electronic address: shaohui.huang@rmp.uhn.on.ca. 2. Department of Radiation Oncology, the Princess Margaret Cancer Centre/University of Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, the Princess Margaret Cancer Centre/University of Toronto, Canada. 3. Department of Biostatistics, the Princess Margaret Cancer Centre/University of Toronto, Canada. 4. Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre/University of Toronto, Canada. 5. Department of Radiation Oncology, the Princess Margaret Cancer Centre/University of Toronto, Canada. 6. Department of Otolaryngology - Head & Neck Surgery, the Princess Margaret Cancer Centre/University of Toronto, Canada. 7. Division of Medical Oncology, the Princess Margaret Cancer Centre/University of Toronto, Canada.
Abstract
PURPOSE: This study examines outcome heterogeneity and potential to refine the TNM-8 cN-classification using radiologic extranodal extension (rENE) in a contemporary HPV-positive (HPV+) oropharyngeal carcinoma (OPC) cohort. METHODS: All HPV+ OPC treated with definitive IMRT from 2010-2015 were included. Pre-treatment CT/MR of cN+ cases were reviewed by a head-neck radiologist for rENE. Overall survival (OS) and disease-free survival (DFS) were compared between rENE-positive (rENE+) vs rENE-negative (rENE-). Multivariable analysis (MVA) for OS confirmed the prognostic value of rENE. Refined cN-classifications for new TNM staging proposals were evaluated against TNM-8 using established criteria. RESULTS: A total of 517 cN+ (rENE+: 97; rENE-: 420) and 41 cN0 cases were identified. The rENE+ proportion increased with rising N-category (N1/N2/N3: 11%/19%/84%, p < 0.001). Median follow-up was 5.1 years. Compared to rENE-, rENE+ patients had a lower 5-year OS (56% vs 85%) and DFS (46% vs 83%) overall, and in N1 (OS: 57% vs 89%; DFS: 51% vs 87%) and N2 subsets (OS: 45% and 76%; DFS: 33% vs 74%) (all p < 0.001). MVA confirmed the prognostic value of rENE for OS (HR = 3.86, p < 0.001) and DFS (HR = 3.89, p < 0.001). We proposed two new cN-classifications: Schema1 reclassified any N_rENE+ as New_N3; Schema2 reclassified N1_rENE+ as New_N2 and N2_rENE+ as New_N3. Stage incorporating either Schema1 (ranked 1st) or Schema2 (ranked 2nd) cN-categories outperformed TNM-8. CONCLUSION: This study confirms that rENE is prognostically important and facilitates understanding of known outcome heterogeneity within TNM-8 in HPV+ OPC patients. rENE is a promising parameter to refine the TNM-8 cN-classifications.
PURPOSE: This study examines outcome heterogeneity and potential to refine the TNM-8 cN-classification using radiologic extranodal extension (rENE) in a contemporary HPV-positive (HPV+) oropharyngeal carcinoma (OPC) cohort. METHODS: All HPV+ OPC treated with definitive IMRT from 2010-2015 were included. Pre-treatment CT/MR of cN+ cases were reviewed by a head-neck radiologist for rENE. Overall survival (OS) and disease-free survival (DFS) were compared between rENE-positive (rENE+) vs rENE-negative (rENE-). Multivariable analysis (MVA) for OS confirmed the prognostic value of rENE. Refined cN-classifications for new TNM staging proposals were evaluated against TNM-8 using established criteria. RESULTS: A total of 517 cN+ (rENE+: 97; rENE-: 420) and 41 cN0 cases were identified. The rENE+ proportion increased with rising N-category (N1/N2/N3: 11%/19%/84%, p < 0.001). Median follow-up was 5.1 years. Compared to rENE-, rENE+ patients had a lower 5-year OS (56% vs 85%) and DFS (46% vs 83%) overall, and in N1 (OS: 57% vs 89%; DFS: 51% vs 87%) and N2 subsets (OS: 45% and 76%; DFS: 33% vs 74%) (all p < 0.001). MVA confirmed the prognostic value of rENE for OS (HR = 3.86, p < 0.001) and DFS (HR = 3.89, p < 0.001). We proposed two new cN-classifications: Schema1 reclassified any N_rENE+ as New_N3; Schema2 reclassified N1_rENE+ as New_N2 and N2_rENE+ as New_N3. Stage incorporating either Schema1 (ranked 1st) or Schema2 (ranked 2nd) cN-categories outperformed TNM-8. CONCLUSION: This study confirms that rENE is prognostically important and facilitates understanding of known outcome heterogeneity within TNM-8 in HPV+ OPC patients. rENE is a promising parameter to refine the TNM-8 cN-classifications.
Authors: Shao Hui Huang; Brian O'Sullivan; Jie Su; Jolie Ringash; Scott V Bratman; John Kim; Ali Hosni; Andrew Bayley; John Cho; Meredith Giuliani; Andrew Hope; Anna Spreafico; Aaron R Hansen; Lillian L Siu; Ralph Gilbert; Jonathan C Irish; David Goldstein; John de Almeida; Li Tong; Wei Xu; John Waldron Journal: Cancer Date: 2020-06-01 Impact factor: 6.860
Authors: Stefano Cavalieri; Mara S Serafini; Andrea Carenzo; Silvana Canevari; Ruud H Brakenhoff; C René Leemans; Irene H Nauta; Frank Hoebers; Mari F C M van den Hout; Kathrin Scheckenbach; Thomas K Hoffmann; Laura Ardighieri; Tito Poli; Pasquale Quattrone; Laura D Locati; Lisa Licitra; Loris De Cecco Journal: JCO Precis Oncol Date: 2021-10-27