HPV and Oropharyngeal Cancer in the Eighth Edition of the TNM Classification: Pitfalls in Practice
HPV and Oropharyngeal Cancer in the Eighth Edition of the TNM Classification: Pitfalls in Practice
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DOI：
10.1016/j.tranon.2019.05.009
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发表时间：
2019-08-01
影响因子：
5
通讯作者：
Tribius, Silke
中科院分区：
文献类型：
--
作者：
Hoffmann, Markus;Tribius, Silke
这篇综述呼吁在口咽癌中应用TNM 8时要注意和精确。根据我们自己的调查和已发表的文献，TNM 8的含义，意图和弱点。在TNM 8中，p16（INK4A）状态对口咽SCC分期的影响强调了i）基础证据缺乏，ii）其分期分组仅具有预后意义，和iii）TNM 8的非关键性应用可能对患者的存活产生负面影响，因为TNM 8具有治疗意图的感知可能导致p16（INK4A）中的治疗方案降级。阳性病例，特别是当分组为I期时，尽管存在颈部转移。如果HPV阳性的其他参数也对患者的生存有负面影响，如吸烟或合并症的存在，在治疗计划中被忽视，生存结果甚至可能变得更糟。应用TNM 8并进一步研究p16（INK4A）作为活动性HPV感染的替代标志物的价值的未来研究将确定TNM 8的变化是否应该在HPV相关的仅p16（INK4A）阳性病例中具有治疗意义，或者这种影响是否也适用于非扁桃体癌。
This review is a call for mindfulness and precision when applying TNM 8 in oropharyngeal cancers. Implications, intentions, and weaknesses of TNM 8 are addressed in light of our own investigations and the published literature. In TNM 8, the impact of p16(INK4A) status on the staging of oropharyngeal SCC highlights i) that underlying evidence is scarce, ii) its stage grouping exclusively has prognostic intention, and iii) that a noncritical application of TNM 8 might negatively impact the patients' survival as the perception of TNM 8 as having therapeutic intention may lead to de-escalating treatment regimens in p16(INK4A)-positive cases, specifically when grouped into stage I despite the presence of neck metastasis. If other parameters from HPV positivity that also have a negative impact on the patient's survival, such as smoking or the presence of comorbidity, are neglected in therapy planning, survival outcomes might even become worse. Future studies applying TNM 8 and further investigating the value of p16(INK4A) as surrogate marker for active HPV infections will identify whether or not changes in TNM 8 should have therapeutic implications in HPV-associated, only p16(INK4A)-positive cases or whether this impact additionally holds true for nontonsillar cancers.