Revising the TNM Classification for HPV-Associated Oropharyngeal Carcinoma: Improving Prognostic Stratification with Imaging-Detected Extranodal Extension

Highlight

• A subset of early-stage HPV-positive oropharyngeal carcinoma patients exhibit unfavorable outcomes, challenging current TNM staging accuracy.
• Imaging-detected extranodal extension (iENE) is identified as the strongest prognostic nodal feature in multivariable analyses.
• Reclassifying N categories upward by one stage in the presence of iENE significantly improves survival prediction compared to the UICC/AJCC eighth edition TNM system.
• The proposed ninth edition TNM schema offers superior risk stratification, supporting optimized treatment and clinical trial design.

Study Background