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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • 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

Published Date

  • November 2016

Published In

Volume / Issue

  • 62 /

Start / End Page

  • 11 - 19

PubMed ID

  • 27865363

Pubmed Central ID

  • PMC5523818

Electronic International Standard Serial Number (EISSN)

  • 1879-0593

Digital Object Identifier (DOI)

  • 10.1016/j.oraloncology.2016.09.004


  • eng

Conference Location

  • England