How applicable for a UK population is the proposed TNM 8 staging for Human Papilloma Virus related Oropharyngeal Squamous Cell Carcinoma?

Bradish T, Kelly C, Paleri V, Robinson M, O’Hara J

Background
The 8th edition of the TNM staging system introduced a new staging model for HPV related oropharyngeal squamous cell carcinoma (OPSCC).  The dataset original study behind this staging system included patients from 7 centres across North America and Europe[1]

Objectives
This study aimed to assess how applicable the HPV OPSCC TNM8 staging model is for a UK population.

Methods
Patient and primary care records were assessed for all patients with HPV+ OPSCC presenting over a 24 month period (2012-13) to the Newcastle MDT.  Patients were staged for TNM7 and TNM8. Disease free and overall survival (OS) was documented.

Results
Seventy patients met the criteria. Staging is shown in table 1. Overall survival is shown in table 2.

TNM Stage	TNM7 Survival	TNM8 Survival
I	2/2 (100%)	30/38 (79%)
II	2/2 (100%)	5/7 (71%)
III	9/11 (82%)	8/15 (53%)
IV A	29/43 (67%)	0/2 (0%)
IV B	1/4 (25%)

Disease free and overall survival will be ready for presentation in May

Conclusions: TNM 8 downstages the majority of patients’ disease. It does not appear to give a more accurate prognosis than TNM7. Caution should be taken in adopting TNM 8. Education is required to ensure treatment intensity is not relaxed as disease stage is reduced.