Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx. (November 2016)

• Record Type: Journal Article
• Authors: Haughey, B.H.; Sinha, P.; Kallogjeri, D.; Goldberg, R.L.; Lewis, J.S.; 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, Jon; 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.
• Is Part Of: Oral oncology. Volume 62(2016:Nov.)
• Page Start: 11
• Page End: 19
• Publication Date: 2016-11
• Subjects: Oropharynx cancer -- Human papillomavirus -- P16 gene -- Staging -- Pathologic staging -- Head and neck cancer -- P16-positive; 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.2016.09.004
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Multi-institutional surgical cohort of 704, p16-positive oropharynx cancer cases. Existing AJCC/UICC pathologic staging lacked prognostic definition. 3 "HPV path " stages identified using pT-classification and node count (⩽4 vs ⩾5). "HPV path " stages were I (T1-T2, ⩽4), II (T1-T2, ⩾5; T3-T4, ⩽4), and III (T3-T4, ⩾5). 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.