High metastatic node number, not extracapsular spread or N-classification is a node-related prognosticator in transorally-resected, neck-dissected p16-positive oropharynx cancer

Sinha, Parul; Kallogjeri, Dorina; Thorstad, Wade L.; Lewis, James S.; Chernock, Rebecca D.; Nussenbaum, Brian; Haughey, Bruce H.

doi:10.1016/j.oraloncology.2015.02.098

Cited by 125 publications

(135 citation statements)

References 24 publications

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“…In multiple cohorts, smoking and TNM status were reported to effect OS (8, 25, 29, 31), which is in contrast to our findings as we found alcohol, but not smoking, had a significant impact on the outcome of OPSCC patients. In our model, smoking might be canceled out due to the high rate of smokers in the HPV-negative group.…”

Section: Discussioncontrasting

confidence: 99%

“…When using clinical staging system on a primarily surgically treated cohort overlap of OS between stages was seen (26). Therefore, classification of N-status was adapted according to number of infiltrated lymph nodes, whereas ECS had no prognostic influence in OS in patients with HPV-associated carcinoma (29). When using those new pathological staging rules, a significant differentiation ( p < 0.001) between stages I vs. II and II vs. III (5-year OS: I 90%, II 84%, III 48%) were seen (26).…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Impact of AJCC/UICC 8th Edition New Staging Rules in Oropharyngeal Squamous Cell Carcinoma

et al. 2017

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IntroductionThe purpose of this study was to test whether the 8th edition of the AJCC/UICC TNM staging system (UICC) precisely differentiates between stages and reflects disease outcome in human papilloma virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC).Patients and methodsOPSCC patients that were diagnosed between 2000 and 2016 were included in this analysis and HPV status was determined by combined DNA and p16 testing. Stratification was done according to 7th and 8th UICC staging rules. Incidence trends of HPV-associated tumorigenesis, 5-year overall survival (OS) according to tumor stages as well as the influence of therapy and prognostic factors toward the outcome were calculated using Kaplan–Meier method and Cox proportional-hazards model.ResultsA significant increase [2000; n = 8/39 (21%)–2015; n = 17/32 (53%); p = 0.002] in HPV-associated OPSCC was seen in the observation period. Together, 150/599 (25.0%) of the patients had HPV-driven OPSCC and 64.7% of curative treatments in all OPSCC patients included upfront surgery of the primary and the neck. 7th edition staging rules led to no discrimination in all respective four UICC stages in HPV OPSCC underlining the need for new staging rules. However, only discrimination between stages I vs. II and III vs. IV was significant in our patients with HPV-OPSCC (94.4 vs. 77.5%; p = 0.031 and 63.9 vs. 25.0%; p = 0.013), and stages II vs. III did not differ in OS rates (p = 0.257), when applying the new staging rules. For HPV-negative OPSCC, significant outcome differences were only seen between UICC stages III vs. IV (57.6 vs. 35.2%; p = 0.012).DiscussionWhile the 7th edition of UICC shows invalid discrimination between stages, the 8th edition is more suitable for HPV-associated carcinoma. Due to lack of differentiation between stages II and III further adaption is essential.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of AJCC/UICC 8th Edition New Staging Rules in Oropharyngeal Squamous Cell Carcinoma

et al. 2017

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“…(3) Adjuvant therapy to the neck should be determined in a multidisciplinary fashion based on the characteristics of both the open biopsy (extracapsular extension, size and number of neck metastases, report of tumor spillage) and the completion neck dissection (additional positive lymph nodes, extracapsular extension, tumor deposits within the prior scar). 13,14,28 These data leave several questions unanswered. First, given the small sample size, a difference in DFS of at least 20% between biopsy and control groups would be necessary to detect a statistically significant difference.…”

Section: Discussionmentioning

confidence: 99%

Definitive Surgical Therapy after Open Neck Biopsy for HPV‐Related Oropharyngeal Cancer

Zenga

Graboyes

Haughey

et al. 2016

Otolaryngol.--head neck surg.

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“…44,53,[61][62][63][64] For example, a study of 220 patients with p16-positive oropharyngeal cancer who received surgical resection with or without adjuvant treatment showed that the presence of ≥5 metastatic nodes is associated with disease recurrence and survival, but extracapsular spread was not significantly associated with outcomes in this sample. 63 Recent studies of patients with p16-positive oropharyngeal cancer treated with surgery show that soft tissue metastasis may be associated with poor survival outcomes, especially in patients with T3-T4 disease. 53,65 These results suggest that patients with p16-positive disease with extracapsular spread could potentially be treated differently than those with p16-negative disease and extracapsular spread.…”

Section: Hpv and Treatment Of Oropharyngeal Cancermentioning

confidence: 95%

NCCN Guidelines Insights: Head and Neck Cancers, Version 2.2017

Adelstein¹,

Gillison²,

Pfister³

et al. 2017

J Natl Compr Canc Netw

283

241

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The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Head and Neck Cancers provide treatment recommendations for cancers of the lip, oral cavity, pharynx, larynx, ethmoid and maxillary sinuses, and salivary glands. Recommendations are also provided for occult primary of the head and neck (H&N), and separate algorithms have been developed by the panel for very advanced H&N cancers. These NCCN Guidelines Insights summarize the panel's discussion and most recent recommendations regarding the increase in human papillomavirus-associated oropharyngeal cancer and the availability of immunotherapy agents for treatment of patients with recurrent or metastatic H&N cancer.

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High metastatic node number, not extracapsular spread or N-classification is a node-related prognosticator in transorally-resected, neck-dissected p16-positive oropharynx cancer

Cited by 125 publications

References 24 publications

Prognostic Impact of AJCC/UICC 8th Edition New Staging Rules in Oropharyngeal Squamous Cell Carcinoma

Prognostic Impact of AJCC/UICC 8th Edition New Staging Rules in Oropharyngeal Squamous Cell Carcinoma

Definitive Surgical Therapy after Open Neck Biopsy for HPV‐Related Oropharyngeal Cancer

NCCN Guidelines Insights: Head and Neck Cancers, Version 2.2017

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