New in Annals of Surgical Oncology

TNM8 for HPV+ oropharyngeal cancer had a structural problem: over 60% of patients were cN1, and over 80% were pathological stage I. Within those early-stage groups, outcomes were heterogeneous and treatment decisions were inconsistent.

TNM9 fixes this with one move: extranodal extension becomes the central nodal modifier.

In this episode: iENE now upstages cN. pENE now upstages pN. pN1 is subdivided into pN1a and pN1b. We walk through what changed, what didn't, and why this is a staging update - not a treatment change.

Listen to Episode 15 (5 min)

Read the full analysis with staging tables

Citation: Evans M, Huang SH, Ho AS, et al. HPV-Associated Oropharyngeal Squamous Cell Carcinoma - Key Updates to the AJCC/UICC TNM9 Staging System. Ann Surg Oncol 2026. doi:10.1245/s10434-026-19496-2

See you next week.

Krishnakumar Thankappan

Head and Neck Oncology Journal Club