Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx

B. H. Haughey, P. Sinha, D. Kallogjeri, R. L. Goldberg, J. S. Lewis, J. F. Piccirillo, R. S. Jackson, E. J. Moore, M. Brandwein-Gensler, S. J. Magnuson, W. R. Carroll, T. M. Jones, M. D. Wilkie, A. Lau, N. S. Upile, Jon Sheard, J. Lancaster, S. Tandon, M. Robinson, D. HusbandI. Ganly, J. P. Shah, D. M. Brizel, B. O'Sullivan, J. A. Ridge, W. M. Lydiatt

Research output: Contribution to journalArticle

48 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)11-19
Number of pages9
JournalOral Oncology
Volume62
DOIs
StatePublished - Nov 1 2016

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Oropharynx
Squamous Cell Carcinoma
Pathology
Neoplasms
Surgical Pathology
Survival
Neoplasm Metastasis
Incidence

Keywords

  • Head and neck cancer
  • Human papillomavirus
  • Oropharynx cancer
  • P16 gene
  • P16-positive
  • Pathologic staging
  • Staging

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research

Cite this

Haughey, B. H., Sinha, P., Kallogjeri, D., Goldberg, R. L., Lewis, J. S., Piccirillo, J. F., ... Lydiatt, W. M. (2016). Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx. Oral Oncology, 62, 11-19. https://doi.org/10.1016/j.oraloncology.2016.09.004

Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx. / Haughey, B. H.; Sinha, P.; Kallogjeri, D.; Goldberg, R. L.; Lewis, J. S.; Piccirillo, J. F.; Jackson, R. S.; Moore, E. J.; Brandwein-Gensler, M.; Magnuson, S. J.; Carroll, W. R.; Jones, T. M.; Wilkie, M. D.; Lau, A.; Upile, N. S.; Sheard, Jon; Lancaster, J.; Tandon, S.; Robinson, M.; Husband, D.; Ganly, I.; Shah, J. P.; Brizel, D. M.; O'Sullivan, B.; Ridge, J. A.; Lydiatt, W. M.

In: Oral Oncology, Vol. 62, 01.11.2016, p. 11-19.

Research output: Contribution to journalArticle

Haughey, BH, Sinha, P, Kallogjeri, D, Goldberg, RL, Lewis, JS, Piccirillo, JF, Jackson, RS, Moore, EJ, Brandwein-Gensler, M, Magnuson, SJ, Carroll, WR, Jones, TM, Wilkie, MD, Lau, A, Upile, NS, Sheard, J, Lancaster, J, Tandon, S, Robinson, M, Husband, D, Ganly, I, Shah, JP, Brizel, DM, O'Sullivan, B, Ridge, JA & Lydiatt, WM 2016, 'Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx', Oral Oncology, vol. 62, pp. 11-19. https://doi.org/10.1016/j.oraloncology.2016.09.004
Haughey BH, Sinha P, Kallogjeri D, Goldberg RL, Lewis JS, Piccirillo JF et al. Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx. Oral Oncology. 2016 Nov 1;62:11-19. https://doi.org/10.1016/j.oraloncology.2016.09.004
Haughey, B. H. ; Sinha, P. ; Kallogjeri, D. ; Goldberg, R. L. ; Lewis, J. S. ; Piccirillo, J. F. ; Jackson, R. S. ; Moore, E. J. ; Brandwein-Gensler, M. ; Magnuson, S. J. ; Carroll, W. R. ; Jones, T. M. ; Wilkie, M. D. ; Lau, A. ; Upile, N. S. ; Sheard, Jon ; Lancaster, J. ; Tandon, S. ; Robinson, M. ; Husband, D. ; Ganly, I. ; Shah, J. P. ; Brizel, D. M. ; O'Sullivan, B. ; Ridge, J. A. ; Lydiatt, W. M. / Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx. In: Oral Oncology. 2016 ; Vol. 62. pp. 11-19.
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title = "Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx",
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.",
keywords = "Head and neck cancer, Human papillomavirus, Oropharynx cancer, P16 gene, P16-positive, Pathologic staging, Staging",
author = "Haughey, {B. H.} and P. Sinha and D. Kallogjeri and Goldberg, {R. L.} and Lewis, {J. S.} and Piccirillo, {J. F.} and Jackson, {R. S.} and Moore, {E. J.} and M. Brandwein-Gensler and Magnuson, {S. J.} and Carroll, {W. R.} and Jones, {T. M.} and Wilkie, {M. D.} and A. Lau and Upile, {N. S.} and Jon Sheard and J. Lancaster and S. Tandon and M. Robinson and D. Husband and I. Ganly and Shah, {J. P.} and Brizel, {D. M.} and B. O'Sullivan and Ridge, {J. A.} and Lydiatt, {W. M.}",
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TY - JOUR

T1 - Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx

AU - Haughey, B. H.

AU - Sinha, P.

AU - Kallogjeri, D.

AU - Goldberg, R. L.

AU - Lewis, J. S.

AU - Piccirillo, J. F.

AU - Jackson, R. S.

AU - Moore, E. J.

AU - Brandwein-Gensler, M.

AU - Magnuson, S. J.

AU - Carroll, W. R.

AU - Jones, T. M.

AU - Wilkie, M. D.

AU - Lau, A.

AU - Upile, N. S.

AU - Sheard, Jon

AU - Lancaster, J.

AU - Tandon, S.

AU - Robinson, M.

AU - Husband, D.

AU - Ganly, I.

AU - Shah, J. P.

AU - Brizel, D. M.

AU - O'Sullivan, B.

AU - Ridge, J. A.

AU - Lydiatt, W. M.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - 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.

AB - 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.

KW - Head and neck cancer

KW - Human papillomavirus

KW - Oropharynx cancer

KW - P16 gene

KW - P16-positive

KW - Pathologic staging

KW - Staging

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