HPV bei Oropharynxkarzinomen in der 8. Ausgabe der TNM-Klassifikation

Zusammenfassung

Die 8. Ausgabe der TNM-Klassifikation ist seit dem 01.01.2017 gültig und beinhaltet Veränderungen dieser Klassifikation für verschiedene Malignome. Solche Änderungen zeigen sich im Kopf-Hals-Bereich für Plattenepithelkarzinome des Oropharynx (OPC): es wird zwischen HPV-positiven und HPV-negativen Karzinomen unterschieden, um durch die daran adaptierte neue Stadieneinteilung die Prognose der Patienten mit OPC insgesamt besser abschätzen zu können. Die Anwendung der neuen TNM-Klassifikation beim HPV-positiven OPC führt in vielen Fällen zu einem signifikanten Downstaging von lokal fortgeschrittener (UICC III/IV) hin zu lokal begrenzter (UICC I/II) Erkrankung. Letzterem zugrundliegende Daten mit einem signifikanten Überlebensvorteil der Patienten mit HPV-positiven OPC entstammen bisher ausschließlich retrospektiven Analysen, die nicht dafür ausgelegt sind zu testen, ob deeskalierte Therapieregime den Überlebensvorteil dieser Patienten erhalten können. Dieser CME-Beitrag versucht Antworten auf offene Fragen hinsichtlich Pathologie, Tumorcharakteristik und Lebensstil-Faktoren zu geben, die für die Prognose dieser Patientenpopulation eine Rolle spielen. Nur die genaue Kenntnis aller Parameter, die die Überlebenszeiten von Patienten mit OPC beeinflussen und die präzise Interpretation vorliegender und noch zu erhebender Daten wird es ermöglichen, den Patienten entsprechend ihrem Risikoprofil die bestmögliche Therapie anzubieten und so das bestmögliche Behandlungsergebnis zu erzielen.

Abstract

The 8th edition of the TNM classification, available since January 1st, 2017, has changed the classification of variou s tumors. For head and neck squamous cell cancer (HNSCC) of the oropharynx (OPC) the new edition distinguishes between HPV-positive and HPV-negative disease to better reflect the prognostic implication of HPV associated disease. In many cases applying the new TNM-classification in HPV-positive OPC results in downstaging of formerly locally advanced disease, i. e. UICC III/ IV, into localized disease UICC stage I/II. However, the data suggesting a better prognosis for patients with HPV associated disease is based on retrospective analyses of studies not primarily designed to answer the question whether or not de-escalated treatment regimes will maintain this survival advantage. This article dedicated to continued medical education (CME) attempts to shed light on many clinical questions still remaining concerning pathology, tumor and life style factors affecting prognosis in this patient population. Only a good understanding of these questions will enable us to interpret data correctly and apply the best possible therapy to our patients according to their risk profile to ensure the best possible outcome.

Schlüsselwörter

Humanes Papillomvirus - Oropharynxkarzinom - Überleben - Risikofaktoren - Rauchen

Key words

Human Papillomavirus - Oropharyngeal Cancer - Vaccination - Survival - Risk Factors

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