Confirmation of proposed human papillomavirus risk–adapted staging according to AJCC/UICC TNM criteria for positive oropharyngeal carcinomas

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Patients with human papillomavirus (HPV)–related oropharyngeal cancers (OPCs) have superior outcomes in comparison with patients with non–HPV-induced OPCs. This study confirms that a previously proposed HPV risk–adapted restaging system better reflects disease outcomes.


The National Cancer Data Base was used to analyze 8803 HPV+ OPC patients. Univariate and multivariate analyses were performed to identify the utility of both American Joint Commission on Cancer (AJCC) staging and HPV risk–adapted staging in predicting the outcomes of patients with HPV+ OPC and other factors influencing survival.


With a median follow-up of 27.1 months, 3.2% had AJCC stage I disease and 6.6%, 19.4%, and 70.9% had stage II, III, and IV disease, respectively. When the patients were restaged according to HPV risk–adapted staging, 76.6% had stage I disease, 9.9% had stage II disease, and 13.5% had stage III disease. The 4-year overall survival rates according to HPV risk–adapted staging were 85.8%, 77.3%, and 64.6% for stages I, II, and III, respectively, but the rates for AJCC stages I, II, III, and IV were 90.1%, 86.1%, 87.0%, and 80.1%, respectively. Patients with HPV+ metastatic disease at diagnosis had a significantly improved median survival of 20.5 months versus 11.1 months with HPV– disease (P < .01). In the multivariate analysis, survival was also affected by the age at treatment, a nontonsillar or base-of-tongue primary site, private insurance, an annual income ≥ $48,000/y, and the comorbidity index (all P values < .01).


Outcomes of HPV+ OPC are significantly improved in comparison with HPV– OPC outcomes, and the current AJCC staging system does not accurately reflect disease outcomes. This study has retrospectively confirmed that an HPV risk–adapted restaging structure more accurately stratifies patients. Under this new risk-stratified staging system, patients may be more accurately stratified for investigation into treatment escalation or de-escalation studies. Cancer2016;122:2021–30. © 2016 American Cancer Society.

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