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Changes in the 8th Edition of the American Joint Committee on Cancer (AJCC) Staging of Head and Neck Cancer: Rationale and Implications

  • Daniella Karassawa Zanoni
  • Snehal G. Patel
  • Jatin P. ShahEmail author
Head and Neck Cancers (EY Hanna, Section Editor)
  • 47 Downloads
Part of the following topical collections:
  1. Topical Collection on Head and Neck Cancers

Abstract

Purpose of Review

The objectives of this article are to review the major changes in the staging of head and neck cancers and the rationale for the modifications.

Recent Findings

Information gathered from various institutional reports lead to a better understanding of the clinical and biological behavior of head and neck tumors, resulting in distinct outcomes, which were used to update the staging system.

Summary

This article reviews the changes in the staging of head and neck cancers published in the 8th edition of the AJCC/UICC TNM staging system.

Keywords

TNM staging Head and neck cancer Squamous cell carcinoma Thyroid cancer HPV-related oropharyngeal cancer 

Notes

Funding Information

This work was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

Compliance with Ethical Standards

Conflict of Interest

Daniella Karassawa Zanoni, Snehal G. Patel, and Jatin P. Shah declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Denoix PF. Note on the possible role of the International Union against Cancer in nomenclature, classification, analytical index, bibliography and documentation. Acta Unio Int Contra Cancrum. 1952;8(Special No):92–6.PubMedGoogle Scholar
  2. 2.
    (UICC), T.U.f.I.C.C. TNM History, Evolution and Milestones. 2017; Available from: https://www.uicc.org/sites/main/files/atoms/files/TNM_History_updated_June2017.pdf.
  3. 3.
    Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al. editors. AJCC Cancer Staging Manual. 8th ed. New York: Springer International Publishing: American Joint Commission on Cancer; 2017.Google Scholar
  4. 4.
    • Lydiatt WM, Patel SG, O'Sullivan B, Brandwein MS, Ridge JA, Migliacci JC, et al. Head and neck cancers–major changes in the American Joint Committee on cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67(2):122–37. This article describes the most significant modifications of the staging system.CrossRefGoogle Scholar
  5. 5.
    • International Consortium for Outcome Research (ICOR) in Head and Neck Cancer), Ebrahimi A, Gil Z, Amit M, Yen TC, Liao CT, et al. Primary tumor staging for oral cancer and a proposed modification incorporating depth of invasion: an international multicenter retrospective study. JAMA Otolaryngol Head Neck Surg. 2014;140(12):1138–48. This retrospective study included a large cohort of oral cancer patients from multiple centers in the world and identified optimal cutpoints for depth of invasion. The models that were evaluated in this study were used to define the changes in the T category of the AJCC 8 th edition. CrossRefGoogle Scholar
  6. 6.
    • Wreesmann VB, Katabi N, Palmer FL, Montero PH, Migliacci JC, Gonen M, et al. Influence of extracapsular nodal spread extent on prognosis of oral squamous cell carcinoma. Head Neck. 2016;38 Suppl 1:E1192-E1199. This study evaluated the microscopic extent of extranodal extension and its prognostic implications for oral cancer.CrossRefGoogle Scholar
  7. 7.
    Ang KK, Sturgis EM. Human papillomavirus as a marker of the natural history and response to therapy of head and neck squamous cell carcinoma. Semin Radiat Oncol. 2012;22(2):128–42.CrossRefGoogle Scholar
  8. 8.
    Chaturvedi AK, Engels EA, Pfeiffer RM, Hernandez BY, Xiao W, Kim E, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol. 2011;29(32):4294–301.CrossRefGoogle Scholar
  9. 9.
    • O'Sullivan B, Huang SH, Su J, Garden AS, Sturgis EM, Dahlstrom K, et al. Development and validation of a staging system for HPV-related oropharyngeal cancer by the International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S): a multicentre cohort study. Lancet Oncol. 2016;17(4):440–51. This study included a large number of patients from multiple centers to create a better staging system for patients with HPV-related oropharyngeal cancer.CrossRefGoogle Scholar
  10. 10.
    Skulsky SL, O'Sullivan B, McArdle O, Leader M, Roche M, Conlon PJ, et al. Review of high-risk features of cutaneous squamous cell carcinoma and discrepancies between the American Joint Committee on Cancer and NCCN Clinical Practice Guidelines In Oncology. Head Neck. 2017;39(3):578–94.CrossRefGoogle Scholar
  11. 11.
    • Nixon IJ, Wang LY, Migliacci JC, Eskander A, Campbell MJ, Aniss A, et al. An international multi-institutional validation of age 55 years as a cutoff for risk stratification in the AJCC/UICC staging system for well-differentiated thyroid cancer. Thyroid. 2016;26(3):373–80. This international retrospective study showed that changing the cutpoint age from 45 to 55 years could prevent overstaging patients with low-risk disease and better estimate prognosis.CrossRefGoogle Scholar
  12. 12.
    Tuttle RM, Haugen B, Perrier ND. Updated American Joint Committee on cancer/tumor-node-metastasis staging system for differentiated and anaplastic thyroid cancer (eighth edition): what changed and why? Thyroid. 2017;27(6):751–6.CrossRefGoogle Scholar
  13. 13.
    Chen F, Lin L, Liu F, Yan L, Qiu Y, Wang J, et al. Three prognostic indexes as predictors of response to adjuvant chemoradiotherapy in patients with oral squamous cell carcinoma after radical surgery: a large-scale prospective study. Head Neck. 2019;41(2):301-308.Google Scholar
  14. 14.
    Bobdey S, Mair M, Nair S, Nair D, Balasubramaniam G, Chaturvedi P. A nomogram based prognostic score that is superior to conventional TNM staging in predicting outcome of surgically treated T4 buccal mucosa cancer: time to think beyond TNM. Oral Oncol. 2018;81:10–5.CrossRefGoogle Scholar
  15. 15.
    Hay A, Migliacci J, Zanoni DK, Patel S, Yu C, Kattan MW, et al. Validation of nomograms for overall survival, cancer-specific survival, and recurrence in carcinoma of the major salivary glands. Head Neck. 2018;40(5):1008–15.CrossRefGoogle Scholar
  16. 16.
    Montero PH, Yu C, Palmer FL, Patel PD, Ganly I, Shah JP, et al. Nomograms for preoperative prediction of prognosis in patients with oral cavity squamous cell carcinoma. Cancer. 2014;120(2):214–21.CrossRefGoogle Scholar
  17. 17.
    Pan JJ, Ng WT, Zong JF, Lee SWM, Choi HCW, Chan LLK, et al. Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy. Cancer. 2016;122(21):3307–15.CrossRefGoogle Scholar
  18. 18.
    Ge MH, Cao J, Wang JY, Huang YQ, Lan XB, Yu B, et al. Nomograms predicting disease-specific regional recurrence and distant recurrence of papillary thyroid carcinoma following partial or total thyroidectomy. Medicine (Baltimore). 2017;96(30):e7575.CrossRefGoogle Scholar
  19. 19.
    Fakhry C, Zhang Q, Nguyen-Tân PF, Rosenthal DI, Weber RS, Lambert L, et al. Development and validation of nomograms predictive of overall and progression-free survival in patients with oropharyngeal cancer. J Clin Oncol. 2017;35(36):4057–65.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Daniella Karassawa Zanoni
    • 1
  • Snehal G. Patel
    • 1
  • Jatin P. Shah
    • 1
    Email author
  1. 1.Head and Neck Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA

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