AJCCUICC 8 th Edition Head and Neck Staging

AJCC/UICC 8 th Edition Head and Neck Staging : Changes in the Wind AJCC/UICC 8 th Edition Head and Neck Staging. “Changes in the Wind” Bruce H Haughey MBCh. B MS FACS Medical Director Oncology, Florida Hospital Celebration Health Orlando, FL

Disclosures l Honorarium: Mayo Clinic 2016 l Textbook Royalties: Elsevier 2016, 17.

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

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

OROPHARYNX Oropharynx: AJCC 7 th Edition Stage Groupings in p 16+, surgically managed (N=704)* * “c”=0. 72

Oropharynnx Cancer Rx Surgical Open approach Intuitive robot Non-surgical Minimally INVASIVE TRANSORAL APPROACH 2015 Transoral laser microsurgery

AJCC/UICC 8 th Edition Staging for Head and Neck Malignancies: Oropharynx 1. Oropharynx SCC: p 16 -positive vs. p 16 -negative patients staged separately 2. Oropharynx SCC: p 16 negative remains (almost) the same 3. Oropharynx SCC: p 16 positive - clinical staging - pathology-based staging - …SEPARATE SYSTEM FOR EACH

AJCC c. T category : ICON-S OPSCC (nonsurgical Rx) study O’Sullivan B et al. Lancet Oncology 17: 44 -51 2016

p. T classification: p 16+ OPSCC cases: holding good! Haughey B et al. Oral Oncology 62: 11 -19 (2016)

AJCC (UICC) 8 th Edition Staging for Head and Neck Malignancies : Oropharynx clin. & path. NM : p 16+ and p 16(Tx and T 1 s remain in p 16 neg) (T 4 b remains in p 16 neg)

l. What about nodal status?

Oral Oncology 2015

Oropharynnx Cancer Rx Surgical Open approach Intuitive robot Non-surgical Minimally INVASIVE TRANSORAL APPROACH 2015 Transoral laser microsurgery

AJCC c. N category: ICON-S OPSCC (nonsurgical Rx) study O’Sullivan B et al. 2016

AJCC (UICC) 8 th Edition Staging for Head and Neck Malignancies : Oropharynx clinical T M : p 16+ “SIDE and SIZE”

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, BA 1; A. Dimitrios Colevas, MD 2; Wendy Hara, MD 3; F. Christopher Holsinger, MD 1; Ingrid Oakley-Girvan, Ph. D, MPH 4, 5, 6, 7; and Vasu Divi, MD 1, 7 Cancer May 1, 2106

AJCC 7 th Edition p. N-classifications Haughey BH et al: Oral Oncology 2016

AJCC (UICC) 8 th Edition Staging for Head and Neck Malignancies : Oropharynx pathologic T M : p 16+ (Numbers {<5>} , size matter : NO N 3)

AJCC (UICC) 8 th Edition Staging for Head and Neck Malignancies : Oropharynx clinical TNM : p 16+Stage Groupings (ipsi) (con/bi) (>6 cm)

AJCC (UICC) 8 th Edition Staging for Head and Neck Malignancies : Oropharynx clinical TNM : p 16+Stage Groupings O’Sullivan et al: 2016

Can we detect pathological stage groupings? l

AJCC (UICC) 8 th Edition Staging for Head and Neck Malignancies : Oropharynx pathologic TNM : p 16+Stage Groupings

AJCC (UICC) 8 th Edition Staging for Head and Neck Malignancies : Oropharynx pathologic TNM : p 16+Stage Groupings LR p<. 001 Haughey et al: 2016

AJCC (UICC) 8 th Edition Staging for Head and Neck Malignancies : Oropharynx pathologic TNM : p 16+Stage Groupings LR p<. 001 Haughey et al: 2016

ICON-S “path” : AJCCICON-S p 16+ path stages p 16+ stages “c”==. 75 “c”. 75 hazard discrimination p 16+ HPVpath stages “c” =. 78

AJCC 8 th ed P 16 -neg OP N-classification.

Extranodal Extension (ENE) AJCC 8 th edition l 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. l Pathologic ENE : “High bar” = no effacement/stretching

Cervical Nodes – 8 th edition Clinical N 1, N 2 a, N 2 b and N 2 c unchanged other than specify without extranodal extension • N 3 a Metastasis in a lymph node more than 6 cm in greatest dimension without extranodal extension • N 3 b Metastasis in a single or multiple lymph nodes with clinical 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 l Pathological l N 1, N 2 a, N 2 b and N 2 c unchanged other than specify without extranodal extension • p. N 3 a Metastasis in a lymph node more than 6 cm in greatest dimension without extranodal extension • p. N 3 b 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

AJCC /UICC 8 th Edition : Head and Neck Thank you!