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Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx

Lookup NU author(s): Dr Max RobinsonORCiD


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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. (C) 2016 Elsevier Ltd. All rights reserved.

Publication metadata

Author(s): Haughey BH, Sinha P, Kallogjeri D, Goldberg RL, Lewis JS, Piccirillo JF, Jackson RS, Moore EJ, Brandwein-Gensler M, Magnuson SJ, Carroll WR, Jones TM, Wilkie MD, Lau A, Upile NS, Sheard J, Lancaster J, Tandon S, Robinson M, Husband D, Ganly I, Shah JP, Brizel DM, O'Sullivan B, Ridge JA, Lydiatt WM

Publication type: Article

Publication status: Published

Journal: Oral Oncology

Year: 2016

Volume: 62

Pages: 11-19

Print publication date: 01/11/2016

Online publication date: 23/09/2016

Acceptance date: 14/09/2016

ISSN (print): 1368-8375

ISSN (electronic): 1879-0593

Publisher: Elsevier


DOI: 10.1016/j.oraloncology.2016.09.004


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