Huang Shao H, Li Jishi, Xu Zhiyuan, O'Sullivan Brian
Department of Radiation Oncology, The Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.
Department of Clinical Oncology, The University of Hong Kong, Shenzhen Hospital, Shenzhen, China.
Curr Opin Otolaryngol Head Neck Surg. 2020 Apr;28(2):100-106. doi: 10.1097/MOO.0000000000000607.
The 8th edition tumor, node, metastasis (TNM) classification (TNM-8) introduced a new classification for human papillomavirus (HPV)-mediated oropharyngeal carcinoma (HPV+ OPC). This review summarizes its potential therapeutic implications focusing on literature published since 2018.
The following are active research areas involved in clinical care and therapy relevant to TNM-8: tumor HPV testing and its clinical implications; stage I disease: treatment selection and lessons learned from recent deintensification trials; emerging strategies addressing stage II and III disease.
The TNM-8 classification depicts prognosis of HPV+ OPC much more reliably compared with TNM-7. Among the advantages in outcome comparison and stratification for clinical trial entry and conduct, it also enables more satisfactory individual patient consultation to adequately estimate prognosis, and facilitates clinical and translational research. However, clinicians must remain mindful that the TNM classification is not a guideline for treatment but, instead, provides a framework for clinical research and treatment decision-making. The TNM-8 has potential to improve risk-tailored treatment algorithms for HPV+ OPC including selection of treatment modality (primary trans-oral surgery vs. radiotherapy, addition of chemotherapy) and adjusting the intensity of approaches. To realize these goals fully, it is apparent that the TNM-8 needs to evolve further.
第八版肿瘤、淋巴结、转移（TNM）分类（TNM-8）引入了一种针对人乳头瘤病毒（HPV）介导的口咽癌（HPV+OPC）的新分类方法。本综述总结了自2018年以来发表的文献中其潜在的治疗意义。
以下是与TNM-8相关的临床护理和治疗方面的活跃研究领域：肿瘤HPV检测及其临床意义；I期疾病：治疗选择以及从近期降强度试验中吸取的经验教训；针对II期和III期疾病的新兴策略。
与TNM-7相比，TNM-8分类更可靠地描述了HPV+OPC的预后。在结果比较以及为临床试验入选和实施进行分层方面的优势中，它还能使个体患者咨询更令人满意，从而充分估计预后，并促进临床和转化研究。然而，临床医生必须牢记，TNM分类不是治疗指南，而是为临床研究和治疗决策提供一个框架。TNM-8有潜力改进针对HPV+OPC的风险调整治疗算法，包括治疗方式的选择（原发性经口手术与放疗、化疗的添加）以及调整治疗方法的强度。为了充分实现这些目标，显然TNM-8需要进一步发展。
