Refining prognostic stratification of human papillomavirus-related oropharyngeal squamous cell carcinoma: different prognosis between T1 and T2

Abstract

PurposeTo validate the 8th edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) TNM staging system for human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) and investigate whether a modified classification better reflects the prognosis.Materials and MethodsMedical records of patients diagnosed with non-metastatic HPV-related OPSCC between 2010 and 2016 at a single institution were retrospectively reviewed. HPV status was determined by immunohistochemical analysis of p16 and/or HPV DNA polymerase chain reaction (PCR). We reclassified TNM stage T0-1 and N0-1 as group A, T2-3 or N2 as B, and T4 or N3 as C. Survival analysis according to 8th AJCC/UICC TNM staging and the modified classification was performed.ResultsOf 383 OPSCC patients, 211 were positive for HPV DNA PCR or p16. After exclusion, 184 patients were included in this analysis. Median age was 56 years (range, 31 to 81 years). Most primary tumors were in the palatine tonsil (148 tumors, 80%). The eighth AJCC/UICC TNM classification could not differentiate between stage I and II (p = 0.470) or II and III (p = 0.209). Applying modified grouping, the 3-year overall survival rate of group A was significantly higher than that of group B and C (98% vs. 91%, p = 0.039 and 98% vs. 78%, p < 0.001, respectively). Differentiation between group B and C was marginally significant (p = 0.053).ConclusionThe 8th AJCC/UICC TNM staging system did not clearly distinguish the prognosis of stage II from that of other stages. Including the T2N0-1 group in stage II may improve prognostic stratification.

Prognostic Value of Radiologic Extranodal Extension in Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma

“…Mizumachi et al (31) demonstrated similar results, reporting a significant difference in 3-year overall survival rate between stages I–II and III. Although T-staging is considered more influential for clinical outcome than N-staging in HPV-related OPSCC (18), we did not find a significant association between T-staging and PFS in the multivariate analysis. This may be due to the relatively small number of T3 and T4 cases (n = 33) and progressive T3 and T4 cases (n = 7).…”

“…The other method used was tumor HPV DNA detection by polymerase chain reaction (PCR)/DNA chip scanning, which can detect 43 subtypes of HPV (high-risk subtypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82 and other lower or undetermined risk subtypes). HPV-related OPSCC was diagnosed when the results of either p16 or HPV DNA PCR were positive (18).…”

Recommendations for determining HPV status in patients with oropharyngeal cancers under TNM8 guidelines: a two-tier approach

“…Use of p16 IHC alone, as per TNM8 staging guidelines, demonstrated improved prognosis in our study but with overlap of stage I and II cancers as reported in some but not all studies. 21–25 As part of an ‘organ preservation’ strategy the primary treatment modality for the majority of patients with OPSCC has been radiotherapy with and without concurrent chemotherapy and as such TNM8 staging criteria has been evaluated primarily in these patients. 13,20 Notably our study and other studies demonstrating overlap of stages I and II included cohorts where the majority of patients received surgery and where use of pathologic TNM8 staging was recommended instead of clinical.…”

Oropharyngeal squamous cell carcinoma: radiomic machine-learning classifiers from multiparametric MR images for determination of HPV infection status

“…P16 immunohistochemistry was performed using CINtec p16 histology (anti-p16 INK4a mouse monoclonal antibody and immunohistochemical detection kit; Roche MTM Laboratories, Heidelberg, Germany) and HPV DNA detection was performed by 16,18,31,33,35,39,45,51,52,56,58,59,68,73,82, and other lower or undetermined risk subtypes) 37 . HPV-positive OPSCC was diagnosed based on the positive results of either p16 or HPV DNA PCR 38 .…”