ArticleClinical and translational radiation oncology2026
Validation of the 9th edition cTNM classification for HPV-positive oropharyngeal carcinoma in a non-endemic Chinese cohort.
Article in Clinical and translational radiation oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: The UICC/AJCC ninth edition (TNM9) incorporated imaging-detected extranodal extension (iENE) as a new cN modifier for HPV-positive oropharyngeal squamous cell carcinoma (OPSCC). This single-institutional study evaluates the prognostic value of iENE and the applicability of the revised cTNM in a non-endemic Chinese cohort. Methods: All patients with non-metastatic HPV-positive OPSCC treated with definitive radiotherapy/chemoradiotherapy (RT/CRT) from 2011 to 2022 were included. The iENE status was evaluated on pre-treatment scans by radiologists to reclassify cN categories and overall stage, which were then compared with the TNM8 cTNM for stage distribution and prognostic performance. Results: Among 191 consecutively-treated cases, 66 (34.6%) were iENE-positive and 125 were iENE-negative, including 8 with N0 disease. Median follow-up was 44.0 months (IQR 34.1-53.8). iENE-positive patients had inferior 3-year progression-free survival (PFS) vs iENE-negative (70.8% vs. 96.8%, p < 0.001) and overall survival (OS) (82.6% vs. 98.3%, p < 0.05). On multivariable analysis (adjusted for smoking and TNM8 stage), iENE remained independently prognostic for PFS (HR 6.67, 95% CI 2.36-18.84, p = 0.001). TNM9 reclassified 22.9% (27/118) of TNM8-cN1 to TNM9-cN2 and 41.5% (17/41) of TNM8-cN2 to TNM9-cN3, corresponding to 21.9% (21/96) stage I-to-II and 29.3% (17/58) stage II-to-III shifts. TNM9 stage classification improved PFS discrimination (C-index: cN 0.754 vs 0.673; stage 0.760 vs 0.714). Conclusion: The 9th edition cTNM classification provides better risk stratification and more balanced stage distribution in this Chinese cohort of HPV-positive OPSCC. Validation in a larger cohort is warranted.
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