Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx Journal Article
| Authors: | Haughey, B. H.; Sinha, P.; Kallogjeri, D.; Goldberg, R. L.; Lewis, J. S., Jr.; Piccirillo, J. F.; Jackson, R. S.; Moore, E. J.; Brandwein-Gensler, M.; Magnuson, S. J.; Carroll, W. R.; Jones, T. M.; Wilkie, M. D.; Lau, A.; Upile, N. S.; Sheard, J.; Lancaster, J.; Tandon, S.; Robinson, M.; Husband, D.; Ganly, I.; Shah, J. P.; Brizel, D. M.; O'Sullivan, B.; Ridge, J. A.; Lydiatt, W. M. |
| Article Title: | Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx |
| Abstract: | Objective The rapid worldwide rise in incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has generated studies confirming this disease as an entity distinct from traditional OPSCC. Based on pathology, surgical studies have revealed prognosticators specific to HPV-positive OPSCC. The current AJCC/UICC staging and pathologic nodal (pN)-classification do not differentiate for survival, demonstrating the need for new, HPV-specific OPSCC staging. The objective of this study was to define a pathologic staging system specific to HPV-positive OPSCC. Methods Data were assembled from a surgically-managed, p16-positive OPSCC cohort (any T, any N, M0) of 704 patients from five cancer centers. Analysis was performed for (a) the AJCC/UICC pathologic staging, (b) newly published clinical staging for non-surgically managed HPV-positive OPSCC, and (c) a novel, pathology-based, “HPVpath” staging system that combines features of the primary tumor and nodal metastases. Results A combination of AJCC/UICC pT-classification and pathology-confirmed metastatic node count (⩽4 versus ⩾5) yielded three groups: stages I (pT1-T2, ⩽4 nodes), II (pT1-T2, ⩾5 nodes; pT3-T4, ⩽4 nodes), and III (pT3-T4, ⩾5 nodes), with incrementally worse prognosis (Kaplan-Meier overall survival of 90%, 84% and 48% respectively). Existing AJCC/UICC pathologic staging lacked prognostic definition. Newly published HPV-specific clinical stagings from non-surgically managed patients, although prognostic, showed lower precision for this surgically managed cohort. Conclusions Three loco-regional “HPVpath” stages are identifiable for HPV-positive OPSCC, based on a combination of AJCC/UICC primary tumor pT-classification and metastatic node count. A workable, pathologic staging system is feasible to establish prognosis and guide adjuvant therapy decisions in surgically-managed HPV-positive OPSCC. © 2016 Elsevier Ltd |
| Keywords: | staging; head and neck cancer; oropharynx cancer; p16 gene; human papillomavirus; pathologic staging; p16-positive |
| Journal Title: | Oral Oncology |
| Volume: | 62 |
| ISSN: | 1368-8375 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2016-11-01 |
| Start Page: | 11 |
| End Page: | 19 |
| Language: | English |
| DOI: | 10.1016/j.oraloncology.2016.09.004 |
| PROVIDER: | scopus |
| PUBMED: | 27865363 |
| PMCID: | PMC5523818 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 2 November 2016 -- Source: Scopus |
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