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International Journal of Clinical Oncology

Validation of the 9th Edition of the UICC TNM classification and the prognostic impact of nodal spread in salivary gland cancer

Authors
Satoshi Kano
Takayoshi Suzuki
Nayuta Tsushima
Hiroshi Idogawa
Masaki Kakumu
Hayato Imanari
Akihiro Homma
Published in
International Journal of Clinical Oncology

Abstract

Background

The 9th edition of the UICC TNM classification redefined N categories and clinical stages for salivary gland cancer (SGC). We validated the prognostic utility of this redefinition and evaluated the impact of anatomical nodal spread.

Methods

We retrospectively analyzed 166 patients with SGC and 93 parotid gland cancer (PGC) patients treated with curative surgery. Cases were restaged according to the TNM classification of the UICC 9th edition. Kaplan–Meier survival curves, Cox models, and statistical indices (AIC, likelihood ratio χ2, C-index) were used to compare the findings based on the 8th and 9th editions. Nodal metastases were classified as “Intraparotid lymph nodes (LNs) only”, “Limited to levels I–III LNs”, and “Beyond levels I–III LNs”.

Results

Kaplan–Meier curves showed clearer separation by N category and clinical stage for the 9th edition, although its prognostic performance by statistical indices was similar to that of the 8th edition. In the PGC surgery subset, LN metastasis, particularly N2 in the 9th edition, was the strongest adverse prognostic factor, and the new 9th edition pathological N categories were also useful. Additionally, prognosis worsened with increasing nodal extent. Twelve patients with metastases beyond levels I–III developed distant metastases despite standard treatment, and 10 with salivary duct carcinoma, indicating potential benefit from adjuvant systemic therapy.

Conclusions

Kaplan–Meier analyses suggested that the 9th edition provided better intercategory discrimination than the 8th edition, despite no statistical superiority being demonstrated. Nodal metastasis extending beyond levels I–III may be a useful biomarker for selecting patients for adjuvant systemic therapy.
Title
Validation of the 9th Edition of the UICC TNM classification and the prognostic impact of nodal spread in salivary gland cancer
Authors
Satoshi Kano
Takayoshi Suzuki
Nayuta Tsushima
Hiroshi Idogawa
Masaki Kakumu
Hayato Imanari
Akihiro Homma
Publication date
08-03-2026
Publisher
Springer Nature Singapore
Published in
International Journal of Clinical Oncology
Print ISSN: 1341-9625
Electronic ISSN: 1437-7772
DOI
https://doi.org/10.1007/s10147-026-02980-w
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Case simulations: Biomarker-driven management of NSCLC (Link opens in a new window)

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How-to guide for healthcare professionals: understanding genomic reports

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