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Staging von Oropharynxkarzinomen

Neue TNM-Klassifikation als Herausforderung für Kopf-Hals-Tumorzentren

Staging of oropharyngeal carcinomas

New TNM classification as a challenge for head and neck cancer centers

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Zusammenfassung

Hintergrund

Die TNM-Klassifikation (TNM: Tumor, Nodus, Metastasen) wird regelmäßig entsprechend der Literatur sowie international abgestimmter Empfehlungen aktualisiert. Ausgeprägte Änderungen haben sich im Rahmen der 8. Auflage v. a. für Oropharynxkarzinome ergeben.

Material und Methoden

Die Änderungen sowie die praktische Anwendung der Klassifikation für das Staging von Oropharynxkarzinomen werden anhand von Fällen aus der Tumordatenbank dargestellt.

Ergebnisse

Die aktuelle Auflage der TNM-Klassifikation setzt Forderungen um, durch humane Papillomaviren (HPV) induzierte von HPV-negativen Tumoren im Rahmen des Stagings zu unterscheiden. Auch die prognostische Bedeutung der extranodalen Ausbreitung von Lymphknotenmetastasen wurde integriert. Während für p16-positive Tumoren in vielen Fällen ein Downstaging hinsichtlich der N‑Kategorie und der Stadien gemäß Union Internationale Contre le Cancer (UICC) stattfindet, führt extranodales Wachstum bei p16-negativen Tumoren zumeist zu einem deutlichen Upstaging. Bei einer begrenzten Spezifität der p16-Immunhistochemie muss die Bedeutung falsch-positiver Ergebnisse beachtet werden. Fehlende Integration des Rauchverhaltens, eine eingeschränkte Standardisierung der Untersuchungstechnik der extranodalen Ausbreitung sowie hohe Anforderungen an die Dokumentationsqualität sollten berücksichtigt werden.

Schlussfolgerung

Inwiefern die Änderungen Überlegungen einer Therapiedeeskalation für p16-positive Karzinome unterstützen, werden laufende Studien zeigen müssen. Im Rahmen einer prospektiven multizentrischen Datenerhebung sollte die universelle Anwendbarkeit, die Angemessenheit für alle Sublokalisationen sowie der prognostische Einfluss der neuen TNM-Auflage ausführlich untersucht werden.

Abstract

Background

The TNM (tumor, nodes, metastasis) classification is updated periodically according to the literature and international recommendations. With the 8th edition, notable changes have been developed especially with regard to oropharyngeal cancer.

Materials and methods

The modifications as well as the practicability of the classification for staging of oropharyngeal cancers are demonstrated on the basis of cases from the tumor database.

Results

The latest edition of the TNM classification realizes requirements to differentiate between human papilloma virus (HPV) positive and HPV-negative tumors during staging. Furthermore, the prognostic relevance of extranodal extension of lymph node metastases was integrated into the classification. While downstaging is performed regarding N category and Union Internationale Contre le Cancer (UICC) stage in many p16-positive tumors, for p16-negative tumors, extranodal spread mostly leads to a notable upstaging. Due to limited specificity of the p16 immunostaining, the relevance of false positive results has to be underlined. Missing integration of smoking behavior, limited standardization of the extranodal extension examination technique, as well as high demands on the documentation quality should be kept in mind.

Conclusion

Clinical trials will have to show whether deescalation strategies regarding p16-positive carcinomas are supported by the changes made in the TNM staging system. A prospective multicenter study should examine the universal applicability, the appropriateness for all sublocations, as well as the prognostic significance of the current edition.

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Authors and Affiliations

  1. Hals-Nasen-Ohrenklinik, Plastische Operationen der Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland

    A. Beltz, D. Gösswein, R. H. Stauber, J. Hagemann, S. Strieth, C. Matthias &  J. Künzel

  2. Gewebe-Biobank der Universitätsmedizin Mainz; Institut für Pathologie, Universitätsmedizin Mainz, Mainz, Deutschland

    S. Zimmer

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Correspondence to J. Künzel.

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Interessenkonflikt

A. Beltz, D. Gösswein, S. Zimmer, R.H. Stauber, J. Hagemann, S. Strieth, C. Matthias und J. Künzel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Beltz, A., Gösswein, D., Zimmer, S. et al. Staging von Oropharynxkarzinomen. HNO 66, 375–382 (2018). https://doi.org/10.1007/s00106-018-0499-0

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