Journal article
Confirmation of proposed human papillomavirus risk-adapted staging according to AJCC/UICC TNM criteria for positive oropharyngeal carcinomas
Cancer, v 122(13), pp 2021-2030
01 Jul 2016
PMID: 27111669
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BACKGROUNDPatients with human papillomavirus (HPV)-related oropharyngeal cancers (OPCs) have superior outcomes in comparison with patients with non-HPV-induced OPCs. This study confirms that a previously proposed HPV risk-adapted restaging system better reflects disease outcomes.
METHODSThe National Cancer Data Base was used to analyze 8803 HPV+ OPC patients. Univariate and multivariate analyses were performed to identify the utility of both American Joint Commission on Cancer (AJCC) staging and HPV risk-adapted staging in predicting the outcomes of patients with HPV+ OPC and other factors influencing survival.
RESULTSWith a median follow-up of 27.1 months, 3.2% had AJCC stage I disease and 6.6%, 19.4%, and 70.9% had stage II, III, and IV disease, respectively. When the patients were restaged according to HPV risk-adapted staging, 76.6% had stage I disease, 9.9% had stage II disease, and 13.5% had stage III disease. The 4-year overall survival rates according to HPV risk-adapted staging were 85.8%, 77.3%, and 64.6% for stages I, II, and III, respectively, but the rates for AJCC stages I, II, III, and IV were 90.1%, 86.1%, 87.0%, and 80.1%, respectively. Patients with HPV+ metastatic disease at diagnosis had a significantly improved median survival of 20.5 months versus 11.1 months with HPV- disease (P < .01). In the multivariate analysis, survival was also affected by the age at treatment, a nontonsillar or base-of-tongue primary site, private insurance, an annual income $48,000/y, and the comorbidity index (all P values < .01).
CONCLUSIONSOutcomes of HPV+ OPC are significantly improved in comparison with HPV- OPC outcomes, and the current AJCC staging system does not accurately reflect disease outcomes. This study has retrospectively confirmed that an HPV risk-adapted restaging structure more accurately stratifies patients. Under this new risk-stratified staging system, patients may be more accurately stratified for investigation into treatment escalation or de-escalation studies. Cancer 2016;122:2021-30. (c) 2016 American Cancer Society.
The current American Joint Commission on Cancer staging system for human papillomavirus-positive oropharyngeal cancers does not accurately reflect disease outcomes. This large, registry-based, retrospective study validates a recently proposed human papillomavirus risk-adapted restaging structure for more accurately risk-stratifying patients on the basis of their observed outcomes.
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Details
- Title
- Confirmation of proposed human papillomavirus risk-adapted staging according to AJCC/UICC TNM criteria for positive oropharyngeal carcinomas
- Creators
- Zachary D. Horne - UPMC Hillman Cancer CenterScott M. Glaser - UPMC Hillman Cancer CenterJohn A. Vargo - UPMC Hillman Cancer CenterRobert L. Ferris - UPMC Hillman Cancer CenterGoundappa K. Balasubramani - University of PittsburghDavid A. Clump - UPMC Hillman Cancer CenterDwight E. Heron - UPMC Hillman Cancer CenterSushil Beriwal - UPMC Hillman Cancer Center
- Publication Details
- Cancer, v 122(13), pp 2021-2030
- Publisher
- Wiley
- Number of pages
- 10
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000379137900011
- Scopus ID
- 2-s2.0-84964510389
- Other Identifier
- 991021897285404721
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- Oncology