Staging HPV-related oropharyngeal cancer: Validation of AJCC-8 in a surgical cohort. (September 2018)

• Record Type: Journal Article
• Authors: Geltzeiler, Mathew; Bertolet, Marnie; Albergotti, William; Gleysteen, John; Olson, Brennan; Persky, Michael; Gross, Neil; Li, Ryan; Andersen, Peter; Kim, Seungwon; Ferris, Robert L.; Duvvuri, Umamaheswar; Clayburgh, Daniel
• Is Part Of: Oral oncology. Volume 84(2018)
• Page Start: 82
• Page End: 87
• Publication Date: 2018-09
• Subjects: Human papilloma virus -- HPV -- Oropharyngeal squamous cell carcinoma -- Oropharyngeal cancer -- American joint committee on cancer -- AJCC -- Cancer staging; 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.2018.07.013
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: The AJCC, 8th edition contains changes to the staging system for HPV+ oropharyngeal SCC. Our multicenter study validates the AJCC-8′s ability to stratify surgical patients. AJCC-8 more effectively risk stratifies patients by OS and DFS than AJCC-7. AJCC-8 pathologic is not more effective than AJCC-8 clinical for OS. AJCC-8 pathologic is more effective than AJCC-8 clinical for DFS. Abstract: Importance: The American Joint Committee on Cancer, 8th edition (AJCC-8) contains a new staging system for human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). Our study aim was to evaluate the effectiveness of the AJCC-8 relative to the AJCC 7th edition (AJCC-7). Materials and methods: A retrospective chart review was performed on a multi-institutional, prospectively collected dataset from two tertiary referral centers. All patients had HPV+ OPSCC treated primarily with surgery. The prognostic value of AJCC-7 and AJCC-8 were compared for 5-year overall survival (OS) and disease-specific survival (DFS). Results: AJCC-8 pathological staging effectively risk stratified patients, creating a Cox model with a better fit (lower Akaike's Information Criterion, p < 0.0001) when compared to AJCC-7 pathological stages for both OS and DFS. The AJCC-8 pathologic staging did not produce a better fit than the AJCC-8 clinical staging (p = 0.15) for OS, however, AJCC-8 pathologic was more effective than AJCC-8 clinical for DFS (p < 0.0001). 76% of patients did not change their stage between clinical and pathologic AJCC-8 staging; 14% were upstaged by 1, <1% were upstaged by 2, 7% were downstaged by 1, and 3% downstaged by 2. Conclusions and relevance: The new AJCC-8 staging system represents a significant improvement over AJCC-7 for risk stratification into groups that predict overall survival and disease-specific survival of surgically treated HPV+ OPSCC patients. The AJCC- 8 pathologic staging system was not significantly better than the AJCC-8 clinical staging system for overall survival, however, the pathologic staging system was better than the clinical for disease free survival.