B H Haughey1, P Sinha2, D Kallogjeri2, R L Goldberg2, J S Lewis3, J F Piccirillo2, R S Jackson2, E J Moore4, M Brandwein-Gensler5, S J Magnuson6, W R Carroll7, T M Jones8, M D Wilkie8, A Lau8, N S Upile8, Jon Sheard9, J Lancaster10, S Tandon10, M Robinson11, D Husband12, I Ganly13, J P Shah13, D M Brizel14, B O'Sullivan15, J A Ridge16, W M Lydiatt17. 1. Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, USA; Department of Surgery, University of Auckland Faculty of Medicine and Health Sciences, Auckland, New Zealand. Electronic address: Bruce.Haughey.MD@flhosp.org. 2. Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA. 3. Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA. 4. Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA. 5. Pathology and Anatomical Sciences, SUNY at the University at Buffalo, Buffalo, NY, USA. 6. Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, USA. 7. Otolaryngology-Head and Neck Surgery, University of Alabama, Birmingham, AL, USA. 8. Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK. 9. Aintree University Hospitals NHS Foundation Trust, Liverpool, UK; Pathology, University of Liverpool, UK. 10. Aintree University Hospitals NHS Foundation Trust, Liverpool, UK. 11. Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle-upon-Tyne, UK. 12. Clatterbridge Cancer Centre, Wirral, UK. 13. Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA. 14. Radiation Oncology, Duke University Medical Center, Durham, NC, USA. 15. Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada. 16. Head and Neck Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA. 17. Clinical Professor, Creighton Department of Surgery, Omaha, NE, USA.
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.
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.
Authors: Joseph Zenga; Michael Wilson; Douglas R Adkins; Hiram A Gay; Bruce H Haughey; Dorina Kallogjeri; Loren S Michel; Randal C Paniello; Jason T Rich; Wade L Thorstad; Brian Nussenbaum Journal: JAMA Otolaryngol Head Neck Surg Date: 2015-12 Impact factor: 6.223
Authors: Eric J Moore; Steven M Olsen; Rebecca R Laborde; Joaquín J García; Francis J Walsh; Daniel L Price; Jeffrey R Janus; Jan L Kasperbauer; Kerry D Olsen Journal: Mayo Clin Proc Date: 2012-03 Impact factor: 7.616
Authors: Brian O'Sullivan; Shao Hui Huang; Lillian L Siu; John Waldron; Helen Zhao; Bayardo Perez-Ordonez; Ilan Weinreb; John Kim; Jolie Ringash; Andrew Bayley; Laura A Dawson; Andrew Hope; John Cho; Jonathan Irish; Ralph Gilbert; Patrick Gullane; Angela Hui; Fei-Fei Liu; Eric Chen; Wei Xu Journal: J Clin Oncol Date: 2013-01-07 Impact factor: 44.544
Authors: P Sinha; W T Thorstad; B Nussenbaum; B H Haughey; D R Adkins; D Kallogjeri; J S Lewis Journal: Oral Oncol Date: 2013-11-06 Impact factor: 5.337
Authors: Jason T Rich; Simon Milov; James S Lewis; Wade L Thorstad; Douglas R Adkins; Bruce H Haughey Journal: Laryngoscope Date: 2009-09 Impact factor: 3.325
Authors: John R de Almeida; Ryan Li; J Scott Magnuson; Richard V Smith; Eric Moore; Georges Lawson; Marc Remacle; Ian Ganly; Dennis H Kraus; Marita S Teng; Brett A Miles; Hilliary White; Umamaheswar Duvvuri; Robert L Ferris; Vikas Mehta; Krista Kiyosaki; Edward J Damrose; Steven J Wang; Michael E Kupferman; Yoon Woo Koh; Eric M Genden; F Christopher Holsinger Journal: JAMA Otolaryngol Head Neck Surg Date: 2015-12 Impact factor: 6.223
Authors: Mathew Geltzeiler; Marnie Bertolet; William Albergotti; John Gleysteen; Brennan Olson; Michael Persky; Neil Gross; Ryan Li; Peter Andersen; Seungwon Kim; Robert L Ferris; Umamaheswar Duvvuri; Daniel Clayburgh Journal: Oral Oncol Date: 2018-07-22 Impact factor: 5.337
Authors: William G Albergotti; Hannah L Schwarzbach; Shira Abberbock; Robert L Ferris; Jonas T Johnson; Umamaheswar Duvvuri; Seungwon Kim Journal: JAMA Otolaryngol Head Neck Surg Date: 2017-12-01 Impact factor: 6.223