Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Nov:62:11-19.
doi: 10.1016/j.oraloncology.2016.09.004. Epub 2016 Sep 23.

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

B H Haughey  1 , P Sinha  2 , D Kallogjeri  2 , R L Goldberg  2 , J S Lewis Jr  3 , J F Piccirillo  2 , R S Jackson  2 , E J Moore  4 , M Brandwein-Gensler  5 , S J Magnuson  6 , W R Carroll  7 , T M Jones  8 , M D Wilkie  8 , A Lau  8 , N S Upile  8 , Jon Sheard  9 , J Lancaster  10 , S Tandon  10 , M Robinson  11 , D Husband  12 , I Ganly  13 , J P Shah  13 , D M Brizel  14 , B O'Sullivan  15 , J A Ridge  16 , W M Lydiatt  17
Affiliations

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

B H Haughey et al. Oral Oncol. 2016 Nov.

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.

Keywords: Head and neck cancer; Human papillomavirus; Oropharynx cancer; P16 gene; P16-positive; Pathologic staging; Staging.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest Statement

None of the co-authors had any conflicts of interest which could have affected the current study.

Figures

Figure 1
Figure 1. Flow diagram depicting study flow
OPSCC: Oropharyngeal squamous cell carcinoma
Figure 2
Figure 2
Kaplan-Meier overall survival by AJCC/UICC stage grouping for oropharynx (log rank, p-value=0.230)
Figure 3
Figure 3
A. Kaplan-Meier overall survival curves of 292 patients used for conjunctive consolidation as a function of HPVpath stages I, II, and III (log rank, p-value<0.001) B. Kaplan-Meier overall survival curves of 704 patients in the overall study cohort as a function of HPVpath stages I, II, and III (log rank, p-value<0.001) C. Kaplan-Meier disease free survival curves of 704 patients as a function of HPVpath I, II, and III (log rank, p-value<0.001)
Figure 4
Figure 4
Figure 4
Figure 4
See this image and copyright information in PMC

References

    1. Chaturvedi AK, Engels Ea, Pfeiffer RM, Hernandez BY, Xiao W, Kim E, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol. 2011;29:4294–301. - PMC - PubMed
    1. Gillison ML. Human papillomavirus-associated head and neck cancer is a distinct epidemiologic, clinical, and molecular entity. Semin Oncol. 2004;31:744–54. - PubMed
    1. Pfister DG, Spencer S, Brizel DM, Burtness B, Busse PM, Caudell JJ, et al. Head and Neck Cancers, Version 1. 2015. J Natl Compr Canc Netw. 2015;13:847–55. - PMC - PubMed
    1. Grant DG, Salassa JR, Hinni ML, Pearson BW, Perry WC. Carcinoma of the tongue base treated by transoral laser microsurgery, part one: Untreated tumors, a prospective analysis of oncologic and functional outcomes. Laryngoscope. 2006;116:2150–5. - PubMed
    1. Rich JT, Milov S, Lewis JS, Thorstad WL, Adkins DR, Haughey BH. Transoral laser microsurgery (TLM) +/− adjuvant therapy for advanced stage oropharyngeal cancer: outcomes and prognostic factors. Laryngoscope. 2009;119:1709–19. - PMC - PubMed

MeSH terms

LinkOut - more resources