Abstract
6014 Background: Changes in 8th TNM edition are a specific staging for p16+oropharyngeal carcinoma and the inclusion of extracapsular spread (ECS) in N extension. We evaluate the improvement in prognostic capacity from the inclusion of the ECS in HNSCC patients treated with a neck dissection (ND). Methods: Retrospective study based on prospectively collected information of 1188 HNSCC patients (oral cavity, HPV-oropharynx, hypopharynx, or larynx) diagnosed from 1990 to 2013, treated with unilateral or bilateral ND and a minimum fw-up of 2 years. We performed 1820 ND: 410 radical, 1410 selective ND; 683 patients (60.1%) had bilateral ND. Mean lymph nodes/patient: 32.6 (SD 19.9, 7-118). In 157 cases (13.8%) ND was performed after radiotherapy (RT, n =71) or chemoradiotherapy (CHRT, n = 86) with a median interval of 8.5 weeks (6-10). 596 patients (52.4%) had postoperative RT (n=525) or CHRT (n=71). Mean fw-up: 5.6 years (SD 4.9): 213 patients (18.7%) had local failure, 158 (13.9%) regional failure, 172 (15.14%) metastases. Results: 570 patients (50.1%) had lymph node metastases, 288 (50.5%) with ECS. The 8th TNM produced upstaging of 20.9% of pN1 patients to pN2a (n=33), and of 58.4% of the patients classified as pN2 to pN3b (n=220). The 7th TNM Classification (7thTNM), 5-year cause-specific survival for pN2 (35.5%) was similar to pN3 (21.6%). In the 8th TNM, 5-year cause-specific survival for pN2 (53.3%) sits in an more intermediate position between pN1 (70.5%) and pN3 (24.0%). Five-year cause-specific survival for pN2 patients with ECS (n=217) was 22.4%, and for patients without ECS (n=157) was 51.4%. There were statistically significant differences in survival between the two reclassified groups (P=0.0001). pN1 patients in the 7thTNM did not show survival differences when stratified by the presence of ECS: 5-y SV: 63.5% for ECS (n=33), 70.5% for non-ECS (n=125) (p=0.838). Conclusions: Inclusion of ECS in the pathological classification of the 8th TNM Classification edition improved the prognostic capacity, as compared with the previous version, basically produced by the migration of 58.4% of pN2 in the 7th TNM to the new pN3b category
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