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

International Collaboration

cited authors

  • Haughey, B. H., Sinha, P., Kallogjeri, D., Goldberg, R. L., Lewis, J. S., Jr., 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.

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

authors

Publication Date

  • November 1, 2016

webpage

published in

category

start page

  • 11

end page

  • 19

volume

  • 62

WoS Citations

  • 24

WoS References

  • 36