Future of the TNM classification and staging system in head and neck cancer

Department of Otolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Head & Neck (Impact Factor: 3.01). 12/2010; 32(12):1693-711. DOI: 10.1002/hed.21361
Source: PubMed

ABSTRACT Staging systems for cancer, including the most universally used TNM classification system, have been based almost exclusively on anatomic information. However, the question arises whether staging systems should be based on this information alone. Other parameters have been identified that should be considered for inclusion in classification systems like the TNM. This is all the more important, as a shift toward nonsurgical treatments for head and neck cancer has been made over the years. For these treatment modalities tumor/biologic characteristics next to anatomic information may be particularly important for treatment choice and outcome. The shortcomings of the current TNM classification system will be discussed, along with suggestions for improvement and expansion of the TNM system based on tumor, patient, and environment-related factors. Further improvement of the TNM classification is expected to result in better treatment choices, outcome and prognostication of patients with head and neck cancer.


Available from: Juan P Rodrigo, May 30, 2015
1 Follower
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: As with most cancers the prognosis in pharyngeal and oral cavity cancer largely depends on tumour stage. Physical examination, including endoscopy should be combined with technical radiologic imaging to record the precise extent of tumour. The TNM staging system of the head and neck region is, in fact, an anatomic staging system that describes the anatomic extent of the primary tumour as well as the involvement of regional lymph nodes and distant metastases. Modifications in the TNM staging system should consider not only the expert opinions and published reports in the literature but the technical advances in technology for improved assessment of tumour extent and the shifting paradigms in therapeutic strategies. "T" stage of the tumour is defined by its size, the depth of the invasion and the involvement of vital structures. In the 7th edition of TNM classification, for stage T4 tumors (larger than 4 cm), subcategories a and b were introduced to indicate the involvement of vital structures and their suitability for surgical resection (except for nasopharynx cancer). Nodal metastasis is the most important predictor of outcome for squamous cell cancer of the head and neck.
    Cancer imaging : the official publication of the International Cancer Imaging Society 01/2014; 14(1):15. DOI:10.1186/1470-7330-14-15 · 1.29 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the changes in the epidemiology of laryngeal squamous cell carcinoma (LSCC) regarding gender, T-stage and subsite distribution, and to identify the potential effect of introducing new therapeutic alternatives for early and advanced stage LSCC. A prospective cohort study of LSCC patients diagnosed and treated at a single tertiary referral center in Norway. Retrospective analysis of prospectively recorded data from 1,616 patients treated for LSCC in all subsites of the larynx during 1983-2010. Females represented an increasing proportion of cases throughout the study (p < 0.01) and presented more often than men with supraglottic cancer (p < 0.01). Marked changes in the distribution of T-stages over time were observed in both early and advanced stage LSCC. T1a glottic tumors constituted 56 % of all early-stage LSCC and were predominantly treated by transoral endoscopic laser surgery. The introduction of chemoradiotherapy for advanced stage LSCC offers a distinct advantage for laryngeal preservation. The increasing proportion of females with LSCC may be explained by changes in smoking habits. The proportion of T1a glottic LSCC gradually increased over time, while T4 supraglottic LSCC became less frequent. Videostroboscopy should be considered mandatory in the diagnosis and follow-up of LSCC. Transoral laser microsurgery is the standard first-line treatment for T1a glottic tumors. Chemoradiotherapy has reduced the number of total laryngectomies and is now regarded as the primary treatment for advanced stage tumors.
    Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 05/2014; 271(12). DOI:10.1007/s00405-014-3100-9 · 1.61 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the prognostic value of total tumor volume (TTV) in patients with laryngeal and hypopharyngeal carcinomas. This study involved 182 patients with previously untreated advanced-stage squamous cell carcinoma of the larynx or hypopharynx. TTV were calculated from pretreatment contrast-enhanced computed tomography images. Univariate and multivariate analyses were used to identify factors associated with overall (OS), disease-specific (DSS), and disease-free survival (DFS). At a median follow-up of 63 months (range, 24-139 months), the 5 year OS, DSS, and DFS rates were 60.2%, 73.1%, and 69.4%, respectively. Multivariate analyses showed that tumor site was an independent predictor of DSS (P = 0.03); Charlson comorbidity index for OS (P = 0.001); second primary cancer for OS (P = 0.008) and DFS (P = 0.001); and vocal fold paralysis for DSS (P = 0.014) and DFS (P = 0.033). Extension to the tongue base was an independent predictor of OS (P = 0.007), DSS (P < 0.001), and DFS (P = 0.017), and TTV ≥8.38 ml was an independent predictor of all three survivals (P < 0.001 each). Radiologically determined TTV is prognostic of survival in patients with advanced-stage laryngeal and hypopharyngeal carcinoma. J. Surg. Oncol. 2013; 108:509-515. © 2013 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 12/2013; 108(8):509-15. DOI:10.1002/jso.23444 · 2.84 Impact Factor