Imbalance Between Clinical and Pathologic Staging in the Updated American Joint Commission on Cancer Staging System for Human Papillomavirus–Positive Oropharyngeal Cancer

Fakhry, Carole; Zevallos, José P.; Eisele, David W.

doi:10.1200/jco.2017.75.2063

Cited by 23 publications

(14 citation statements)

References 19 publications

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“…These observations may be a reflection of the eligibility criteria for the trials (restricted to AJCC seventh edition stages III‐IV; age cutoff value; and exclusions based on comorbidities, performance status, and selection bias) and uniform treatments. However, other analyses have observed similar limitations in the application of the new staging system …”

Section: Discussionmentioning

confidence: 76%

“…However, other analyses have observed similar limitations in the application of the new staging system. [17][18][19][20][21][22] Prior analyses of RTOG-0129 have shown no difference with regard to acute or late toxicities by HPV tumor status. 23 In the current assessment, patients in the low-risk group were more symptomatic in the short-term, without long-term differences.…”

Section: Discussionmentioning

confidence: 99%

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Validation of NRG oncology/RTOG‐0129 risk groups for HPV‐positive and HPV‐negative oropharyngeal squamous cell cancer: Implications for risk‐based therapeutic intensity trials

Fakhry

Zhang

Gillison

et al. 2019

Cancer

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Background Radiation Therapy Oncology Group (RTOG)‐0129 recursive partitioning analysis was the basis for risk‐based therapeutic intensification trials for oropharyngeal cancer (OPC). To the authors’ knowledge, the question of whether RTOG‐0129 overall survival (OS) estimates for low‐risk, intermediate‐risk, and high‐risk groups are similar in other data sets or applicable to progression‐free survival (PFS) is unknown. Therefore, the authors evaluated whether survival differences between RTOG‐0129 risk groups persist at 5 years, are reproducible in an independent clinical trial, and are applicable to PFS, and whether toxicities differ across risk groups. Methods Prospective randomized clinical trials were analyzed retrospectively. RTOG‐0129 evaluated standard versus accelerated fractionation radiotherapy concurrent with cisplatin. RTOG‐0522 compared the combination of cisplatin and accelerated fractionation with or without cetuximab. Patients with OPC with available p16 status and tobacco history were eligible. Results There was a total of 260 patients and 287 patients, respectively, from RTOG‐0129 and RTOG‐0522, with median follow‐ups for surviving patients of 7.9 years (range, 1.7‐9.9 years) and 4.7 years (range, 0.1‐7.0 years), respectively. Previous OS differences in RTOG‐0129 persisted at 5 years. In RTOG‐0522, the 5‐year OS rates for the low‐risk, intermediate‐risk, and high‐risk groups were 88.1%, 69.9%, and 45.1%, respectively (P for trend, <.001). The 5‐year PFS rates for the same 3 groups were 72.9%, 56.1%, and 42.2%, respectively. In RTOG‐0522 among a subgroup of patients considered to be at very good risk (p16‐positive disease, smoking history of ≤10 pack‐years, and classified with T1‐T2 disease with ipsilateral lymph nodes measuring ≤6 cm or T3 disease without contralateral or >6 cm lymph nodes), the 5‐year OS and PFS rates were 93.8% and 82.2%, respectively. Overall rates of acute and late toxicities were similar by risk group. Conclusions RTOG‐0129 risk groups persisted at 5 years and were reproducible in RTOG‐0522. However, there was variability in the estimates. These data underscore the importance of long‐term follow‐up and appropriate patient selection in therapeutic deintensification trials.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Validation of NRG oncology/RTOG‐0129 risk groups for HPV‐positive and HPV‐negative oropharyngeal squamous cell cancer: Implications for risk‐based therapeutic intensity trials

Fakhry

Zhang

Gillison

et al. 2019

Cancer

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“…Data from another study of 702 HPV-positive OPSCC patients diagnosed by CT and/or MRI was incorporated into the findings of the ICON-S study to develop a clinical staging system [ 24 ]. Interestingly, in that study, the survival rate for patients with pathological stage III disease was based on only 23 patients [ 38 ]. For this reason, the survival estimates may not be reliable.…”

Section: Controversiesmentioning

confidence: 99%

A review of the 8th edition of the AJCC staging system for oropharyngeal cancer according to HPV status

Machczyński

Majchrzak

Niewinski

et al. 2020

Eur Arch Otorhinolaryngol

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Background The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has increased substantially in recent decades, particularly p16-positive human papillomavirus (HPV)-related OPSCC, which has risen by 50% in western countries. HPV-positivity is the most favourable non-anatomic predictor of oropharyngeal cancer outcomes, which underscores the importance of incorporating this variable into the cancer staging system. Methods In the present article, we review the differences between the 7th and 8th editions of the AJCC staging system, with particular focus on the role of HPV-positivity in patients with head and neck cancer. Results In the previous edition (7th edition) of the AJCC/UICC manual, HPV status and its correlation with nodal metastasis were not considered, thereby leading to incorrect lymph node (N) staging and, potentially, inadequate treatment and worse outcomes. The 8th edition of the AJCC manual addresses these issues, providing more accurate discrimination between groups and better risk stratification in patients with HPV-positive OPSCC. In the future, additional adjustments are likely to be needed, such as unification of the pathological and clinical staging models. Conclusions The new staging system is substantially more accurate than the previous system and should be widely adopted in routine clinical practice.

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“…[19][20][21] Further, the distribution of patients in the 3 stages is not well balanced, with almost 60% of patients assigned to stage I. [19][20][21][22] These findings will be addressed in future editions. For now, however, the systems are a major improvement, and there are not enough data to diverge from them in the current ICCR data set.…”

Section: Separate Cancer Staging Data Setsmentioning

confidence: 98%

Data Set for the Reporting of Carcinomas of the Nasopharynx and Oropharynx: Explanations and Recommendations of the Guidelines From the International Collaboration on Cancer Reporting

Lewis

Adelstein

Agaimy

et al. 2018

Archives of Pathology &Amp; Laboratory Medicine

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The International Collaboration on Cancer Reporting was established to internationally unify and standardize the pathologic reporting of cancers based on collected evidence, as well as to allow systematic data collection across institutions and countries to guide cancer care in the future. An expert panel was convened to identify the minimum data set of elements that should be included in cancer reporting from tumors of the nasopharynx and oropharynx. Specifically, there has been a significant change in practice as a result of identifying oncogenic viruses, including human papillomavirus and Epstein-Barr virus, because they preferentially affect the oropharynx and nasopharynx, respectively. For these anatomic sites, when viral association is taken into account, usually reported elements of in situ versus invasive tumor, depth of invasion, and degree of differentiation are no longer applicable. Thus, guidance about human papillomavirus testing in oropharyngeal carcinomas and Epstein-Barr virus testing in nasopharyngeal carcinomas is highlighted. Further, the clinical and the pathologic differences in staging as proposed by the 8th edition of the Union for International Cancer Control are incorporated into the discussion, pointing out several areas of continued study and further elaboration. A summary of the International Collaboration on Cancer Reporting guidelines for oropharyngeal and nasopharyngeal carcinomas is presented, along with discussion of the salient evidence and practical issues.

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Imbalance Between Clinical and Pathologic Staging in the Updated American Joint Commission on Cancer Staging System for Human Papillomavirus–Positive Oropharyngeal Cancer

Cited by 23 publications

References 19 publications

Validation of NRG oncology/RTOG‐0129 risk groups for HPV‐positive and HPV‐negative oropharyngeal squamous cell cancer: Implications for risk‐based therapeutic intensity trials

Validation of NRG oncology/RTOG‐0129 risk groups for HPV‐positive and HPV‐negative oropharyngeal squamous cell cancer: Implications for risk‐based therapeutic intensity trials

A review of the 8th edition of the AJCC staging system for oropharyngeal cancer according to HPV status

Data Set for the Reporting of Carcinomas of the Nasopharynx and Oropharynx: Explanations and Recommendations of the Guidelines From the International Collaboration on Cancer Reporting

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