AJCC/UICC 8th Edition Head and Neck Staging Changes

This content delves into the changes in staging guidelines for head and neck malignancies as per the 8th edition of the AJCC/UICC criteria. It explores the modifications in staging for oropharynx cancer, neck metastatic disease, oral cavity depth of invasion, and cutaneous malignancies. The presentation touches on the importance of hazard discrimination, balance between patient groups, and the high predictive ability of the staging system. Additionally, it discusses specific aspects such as p16-positive versus p16-negative oropharynx squamous cell carcinoma patients, different staging for these subcategories, and the impact of minimally invasive transoral approaches in oropharynx cancer treatment. The content also mentions studies and research publications that have contributed to the refinement of staging classifications for head and neck cancers.

• Head and Neck Staging
• AJCC/UICC
• Oropharynx Cancer
• Staging Guidelines
• Minimally Invasive Surgery

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1. AJCC/UICC 8th Edition Head and Neck Staging : Changes in the Wind HomeButton.png AJCC/UICC 8thEdition Head and Neck Staging. Changes in the Wind Bruce H Haughey MBChB MS FACS Medical Director Oncology, Florida Hospital Celebration Health Orlando, FL

2. HomeButton.png Disclosures Honorarium: Mayo Clinic 2016 Textbook Royalties: Elsevier 2016,17.

3. HomeButton.png AJCC(UICC) 8th Edition Staging for Head and Neck Malignancies: Changes Oropharynx cancer Neck metastatic disease for UADT SCC Oral cavity: depth of invasion Cutaneous malignancies

4. HomeButton.png Tenets of Staging (Groome PA et al, 2001) Hazard Discrimination (significantly different survivals) Balance between groups (roughly equal numbers) High predictive ability (good approximation of prognosis for individual patient)

5. HomeButton.png OROPHARYNX * Oropharynx: AJCC 7th Edition Stage Groupings in p16+, surgically managed (N=704)* c =0.72

6. HomeButton.png Oropharynnx Cancer Rx Surgical Minimally INVASIVE TRANSORAL APPROACH 2015 Transoral laser microsurgery

7. HomeButton.png AJCC/UICC 8th Edition Staging for Head and Neck Malignancies: Oropharynx Oropharynx SCC: p16-positive vs. p16-negative patients staged separately 1. Oropharynx SCC: p16 negative remains (almost) the same 2. Oropharynx SCC: p16 positive - clinical staging 3. - pathology-based staging - SEPARATE SYSTEM FOR EACH

8. HomeButton.png AJCC cT category : ICON-S OPSCC (nonsurgical Rx) study O Sullivan B et al. Lancet Oncology 17:44-51 2016

9. HomeButton.png pT classification: p16+ OPSCC cases: holding good! Haughey B et al. Oral Oncology 62:11-19 (2016)

10. HomeButton.png AJCC (UICC) 8th Edition Staging for Head and Neck Malignancies : Oropharynx clin. & path. TNM : p16+ and p16- (Tx and T1s remain in p16 neg) (T4b remains in p16 neg)

11. HomeButton.png What about nodal status?

12. HomeButton.png Oral Oncology 2015

13. HomeButton.png Oropharynnx Cancer Rx Surgical Minimally INVASIVE TRANSORAL APPROACH 2015 Transoral laser microsurgery

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15. HomeButton.png AJCC cN category: ICON-S OPSCC (nonsurgical Rx) study O Sullivan B et al. 2016

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18. HomeButton.png AJCC (UICC) 8th Edition Staging for Head and Neck Malignancies : Oropharynx clinical TNM : p16+ SIDE and SIZE

19. HomeButton.png Number of Positive Nodes Is Superior to the Lymph Node Ratio and American Joint Committee on Cancer N Staging for the Prognosis of Surgically Treated Head and Neck Squamous Cell Carcinomas Thomas J. Roberts, BA1; A. Dimitrios Colevas, MD2; Wendy Hara, MD3; F. Christopher Holsinger, MD1; Ingrid Oakley-Girvan, PhD, MPH4,5,6,7; and Vasu Divi, MD1,7 Cancer May 1, 2106

20. HomeButton.png AJCC 7th Edition pN-classifications Haughey BH et al: Oral Oncology 2016

21. HomeButton.png AJCC (UICC) 8th Edition Staging for Head and Neck Malignancies : Oropharynx pathologic TNM : p16+ (Numbers {<5>} , size matter : NO N3)

22. HomeButton.png AJCC (UICC) 8th Edition Staging for Head and Neck Malignancies : Oropharynx clinical TNM : p16+Stage Groupings (ipsi) (>6cm) (con/bi)

23. HomeButton.png AJCC (UICC) 8th Edition Staging for Head and Neck Malignancies : Oropharynx clinical TNM : p16+Stage Groupings O Sullivan et al: 2016

24. HomeButton.png Can we detect pathological stage groupings?

25. HomeButton.png AJCC (UICC) 8th Edition Staging for Head and Neck Malignancies : Oropharynx pathologic TNM : p16+Stage Groupings

26. HomeButton.png AJCC (UICC) 8th Edition Staging for Head and Neck Malignancies : Oropharynx pathologic TNM : p16+Stage Groupings LR p<.001 Haughey et al: 2016

27. HomeButton.png AJCC (UICC) 8th Edition Staging for Head and Neck Malignancies : Oropharynx pathologic TNM : p16+Stage Groupings LR p<.001 Haughey et al: 2016

28. HomeButton.png ICON-S path : hazard discrimination p16+ HPVpath stages c = .78 AJCC p16+ path stages c =.75 c = .75 p16+ ICON-S stages

29. HomeButton.png AJCC 8th ed P16-neg OP N-classification.

30. HomeButton.png Extranodal Extension (ENE) AJCC 8th edition Clinical ENE : High bar for inclusion. ONLY if clinical node evaluation ie fixity, skin erosion, cranial or other (plausible) nerve dysfunction is present: may be supported, but not established by radiologic reading. Pathologic ENE : High bar = no effacement/stretching

31. Cervical Nodes 8th edition HomeButton.png Pathological Clinical N1, N2a, N2b and N2c unchanged other than specify without extranodal extension N1, N2a, N2b and N2c unchanged other than specify without extranodal extension N3a more than 6cm in greatest dimension without extranodal extension Metastasis in a lymph node pN3a Metastasis in a lymph node more than 6 cm in greatest dimension without extranodal extension N3b multiple lymph nodes with clinical extranodal extension* Metastasis in a single or pN3b Metastasis in a lymph node more than 3 cm in greatest dimension with extranodal extension or, multiple ipsilateral, or any contralateral or bilateral node(s) with extranodal extension * The presence of skin involvement or soft tissue invasion with deep fixation/tethering to underlying muscle or adjacent structures or clinical signs of nerve involvement is classified as clinical extra nodal extension

32. HomeButton.png AJCC /UICC 8th Edition : Head and Neck Thank you!