Mathew Geltzeiler1, Marnie Bertolet2, William Albergotti3, John Gleysteen4, Brennan Olson5, Michael Persky6, Neil Gross7, Ryan Li1, Peter Andersen1, Seungwon Kim8, Robert L Ferris8, Umamaheswar Duvvuri8, Daniel Clayburgh9. 1. Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA. 2. Department of Epidemiology and Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA. 3. Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA. 4. Department of Otolaryngology-Head and Neck Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA. 5. School of Medicine, Oregon Health and Science University, Portland, OR, USA. 6. Department of Otolaryngology, Head and Neck Surgery, New York University School of Medicine, New York, NY, USA. 7. Department of Otolaryngology-Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA. 8. Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 9. Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA; Veterans Affairs Portland Health Care System, Portland, OR, USA. Electronic address: clayburg@ohsu.edu.
Abstract
IMPORTANCE: The American Joint Committee on Cancer, 8th edition (AJCC-8) contains a new staging system for human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). Our study aim was to evaluate the effectiveness of the AJCC-8 relative to the AJCC 7th edition (AJCC-7). MATERIALS AND METHODS: A retrospective chart review was performed on a multi-institutional, prospectively collected dataset from two tertiary referral centers. All patients had HPV+ OPSCC treated primarily with surgery. The prognostic value of AJCC-7 and AJCC-8 were compared for 5-year overall survival (OS) and disease-specific survival (DFS). RESULTS: AJCC-8 pathological staging effectively risk stratified patients, creating a Cox model with a better fit (lower Akaike's Information Criterion, p < 0.0001) when compared to AJCC-7 pathological stages for both OS and DFS. The AJCC-8 pathologic staging did not produce a better fit than the AJCC-8 clinical staging (p = 0.15) for OS, however, AJCC-8 pathologic was more effective than AJCC-8 clinical for DFS (p < 0.0001). 76% of patients did not change their stage between clinical and pathologic AJCC-8 staging; 14% were upstaged by 1, <1% were upstaged by 2, 7% were downstaged by 1, and 3% downstaged by 2. CONCLUSIONS AND RELEVANCE: The new AJCC-8 staging system represents a significant improvement over AJCC-7 for risk stratification into groups that predict overall survival and disease-specific survival of surgically treated HPV+ OPSCC patients. The AJCC- 8 pathologic staging system was not significantly better than the AJCC-8 clinical staging system for overall survival, however, the pathologic staging system was better than the clinical for disease free survival. Published by Elsevier Ltd.
IMPORTANCE: The American Joint Committee on Cancer, 8th edition (AJCC-8) contains a new staging system for human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). Our study aim was to evaluate the effectiveness of the AJCC-8 relative to the AJCC 7th edition (AJCC-7). MATERIALS AND METHODS: A retrospective chart review was performed on a multi-institutional, prospectively collected dataset from two tertiary referral centers. All patients had HPV+ OPSCC treated primarily with surgery. The prognostic value of AJCC-7 and AJCC-8 were compared for 5-year overall survival (OS) and disease-specific survival (DFS). RESULTS:AJCC-8 pathological staging effectively risk stratified patients, creating a Cox model with a better fit (lower Akaike's Information Criterion, p < 0.0001) when compared to AJCC-7 pathological stages for both OS and DFS. The AJCC-8 pathologic staging did not produce a better fit than the AJCC-8 clinical staging (p = 0.15) for OS, however, AJCC-8 pathologic was more effective than AJCC-8 clinical for DFS (p < 0.0001). 76% of patients did not change their stage between clinical and pathologic AJCC-8 staging; 14% were upstaged by 1, <1% were upstaged by 2, 7% were downstaged by 1, and 3% downstaged by 2. CONCLUSIONS AND RELEVANCE: The new AJCC-8 staging system represents a significant improvement over AJCC-7 for risk stratification into groups that predict overall survival and disease-specific survival of surgically treated HPV+ OPSCC patients. The AJCC- 8 pathologic staging system was not significantly better than the AJCC-8 clinical staging system for overall survival, however, the pathologic staging system was better than the clinical for disease free survival. Published by Elsevier Ltd.
Entities:
Keywords:
AJCC; American joint committee on cancer; Cancer staging; HPV; Human papilloma virus; Oropharyngeal cancer; Oropharyngeal squamous cell carcinoma
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