AJCC-8ed nodal staging does not predict outcomes in surgically managed HPV-associated oropharyngeal cancer. (July 2018)

• Record Type: Journal Article
• Authors: Hobelmann, Kealan C.; Topf, Michael C.; Bar-Ad, Voichita; Luginbuhl, Adam J.; Keane, William M.; Curry, Joseph M.; Cognetti, David M.
• Is Part Of: Oral oncology. Volume 82(2018)
• Page Start: 138
• Page End: 143
• Publication Date: 2018-07
• Subjects: Head and neck cancer -- TORS -- HPV -- Staging -- Oropharyngeal cancer -- Neck dissection -- Robotic -- Transoral; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2018.05.016
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: The AJCC-8ed system represents an improvement in the staging of HPV-positive OPSCC. AJCC-8ed pathologic N-stage is not predictive of recurrence for HPV-positive OPSCC. TORS with appropriate adjuvant therapy provides excellent locoregional control. Abstract: Objective: To assess the pathological outcomes of surgically-managed human papillomavirus (HPV) positive oropharyngeal squamous cell carcinoma (OPSCC) using the 8th Edition of the American Joint Committee on Cancer Staging Manual (AJCC-8ed). Materials and methods: A retrospective review was conducted of 156 patients with previously untreated OPSCC who underwent primary TORS between March 2010 and February 2015 to evaluate the impact of the new AJCC-8ed pathologic staging system. Only patients who had complete pathologic staging with neck dissection and at least 2 years of follow-up records or disease recurrence within 2 years were included for analysis. Results and conclusions: Of the 156 patients, 116 patients had neck dissections and adequate follow-up data. There were 10 total recurrences, including 2 regional recurrences and 1 local recurrence. Lymph node size, number of positive lymph nodes, and presence of any positive nodes were not associated with recurrence for HPV-positive patients. The presence of extranodal extension approached significance. Pathologic N-stage was not predictive of recurrence under the AJCC-7ed or the AJCC-8ed systems. Cancer staging under the AJCC-8ed, but not the AJCC-7ed system was significantly associated with recurrence. In conclusion, pathologic node status as defined in the AJCC-8ed pathologic staging system does not appear to drive prognosis for surgically managed patients. While the new AJCC-8ed staging is an improvement in prognostication, the use of T-stage alone is still a better predictor of recurrence. TORS with adjuvant therapy determined by pathologic findings provides excellent locoregional control for HPV-positive OPSCC.