AJCC-8ed nodal staging does not predict outcomes in surgically managed HPV-associated oropharyngeal cancer

Hobelmann, Kealan; Topf, Michael C.; Bar‐Ad, Voichita; Luginbuhl, Adam; Keane, William M.; Curry, Joseph; Cognetti, David M.

doi:10.1016/j.oraloncology.2018.05.016

Cited by 22 publications

(18 citation statements)

References 20 publications

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“…In the current study cohort of patients treated with upfront TORS followed by pathology‐directed adjuvant therapy(s), no relationship between smoking status and RFS was demonstrated. The locoregional control rate of 97.5% and distant failure rate of 4.6% noted in the current study are similar to other large TORS series …”

Section: Discussionsupporting

confidence: 91%

Evaluating the impact of smoking on disease‐specific survival outcomes in patients with human papillomavirus–associated oropharyngeal cancer treated with transoral robotic surgery

Roden

Hobelmann

Vimawala

et al. 2020

Cancer

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BACKGROUND: When treated nonsurgically with definitive chemoradiation, smokers with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) have a worse prognosis compared with their nonsmoking counterparts. To the authors' knowledge, the prognostic significance of smoking in surgically treated patients is unknown. METHODS: The current study is a retrospective case series of patients with HPV-positive OPSCC who underwent upfront transoral robotic surgery at a single institution from 2010 through 2017. Exclusion criteria were nonoropharyngeal primary tumors, histology other than SCC, HPV-negative tumors, previous history of head and neck cancer, and/or previous head and neck radiotherapy. Recurrence-free survival (RFS), overall survival, and disease-specific survival were compared using the Kaplan-Meier method and the log-rank test. Smoking history was categorized as never smokers (<1 pack-year), current smokers (smoking at the time of the cancer diagnosis), and former smokers. RESULTS: A total of 258 patients met the study criteria. The average age was 60 years, and approximately 87% of patients were male. A total of 148 patients (57.4%) were smokers whereas 110 (42.6%) reported never smoking. There were 44 active smokers (17.1%) and 104 former smokers (40.3%). The median follow-up was 3.23 years. There were 17 patients of disease recurrence. Smoking pack-year history was not found to be significant for RFS (hazard ratio, 1.01; 95% CI, 0.99-1.03 [P = .45]). There was no significant difference in RFS noted between never and ever smokers (92% vs 89.8%; P = .85) nor was there a difference observed between never, former, and current smokers (92% vs 91.5% vs 86.1%, respectively; P = .69). CONCLUSIONS: A smoking history is common in patients with HPV-positive OPSCC. In the current study, HPV-positive smokers were found to have excellent survival and locoregional control, similar to their nonsmoking counterparts.The results of the current study do not support the exclusion of smokers with early-stage, HPV-positive OPSCC from transoral robotic surgery-based deintensification trials.

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Section: Discussionsupporting

confidence: 91%

Evaluating the impact of smoking on disease‐specific survival outcomes in patients with human papillomavirus–associated oropharyngeal cancer treated with transoral robotic surgery

Roden

Hobelmann

Vimawala

et al. 2020

Cancer

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“…The few studies to date that have characterized recurrence‐associated factors specifically in HPV‐OPC have identified primary tumor category, lymph node category, and tobacco use . High‐risk disease features known to be prognostic for RFS in HPV‐negative HNSCC but of unclear prognostic significance in HPV‐OPC include primary tumor resection margin status, LVI, PNI, and ENE . Combinations of these clinicopathologic factors are currently in place to stratify risk in deintensification studies .…”

Section: Discussionmentioning

confidence: 99%

“…4,23,[29][30][31] High-risk disease features known to be prognostic for RFS in HPV-negative HNSCC but of unclear prognostic significance in HPV-OPC include primary tumor resection margin status, LVI, PNI, and ENE. [32][33][34][35][36] Combinations of these clinicopathologic factors are currently in place to stratify risk in deintensification studies. 10,37 The success of these studies is dependent on accurate patient selection, yet there is no consensus on the clinicopathologic criteria that constitute intermediate-risk disease.…”

Section: Discussionmentioning

confidence: 99%

Tumor‐infiltrating lymphocyte quantification stratifies early‐stage human papillomavirus oropharynx cancer prognosis

et al. 2019

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Objectives/Hypothesis To evaluate if a simple method for assessing tumor‐infiltrating lymphocytes (TIL) in primary tumor specimens improves the prognostic value of the American Joint Committee on Cancer, 8th Edition (AJCC8) cancer staging system in human papillomavirus–positive oropharyngeal squamous cell carcinoma (HPV‐OPC). Study Design Retrospective study. Methods In this study, TIL density was quantified on hematoxylin and eosin (H&E)–stained specimens from patients presenting to Johns Hopkins Hospital between 2009 and 2017 who underwent primary surgical therapy and had primary tumor specimens available for analysis. The prognostic effect of TIL density was evaluated by Kaplan‐Meier method and Cox proportional hazards models considering recurrence‐free survival (RFS) as the primary outcome. Results This study included 132 patients. Ninety‐five percent were classified by clinical criteria with AJCC8 early‐stage disease (stage I: 82%, stage II: 13%). After 84 months of follow‐up, 15 recurrences were observed. Among clinically early‐stage disease, TILhigh status was associated with improved RFS compared to TILlow (P = .002). Adjusted analysis showed TILhigh status was associated with 79% lower risk of recurrence than TILlow (adjusted hazard ratio [aHR]: 0.210, 95% confidence interval [CI]: 0.061‐0.723). In clinical stage I disease, TILhigh status was associated with improved RFS compared to TILlow in both univariate and multivariate analyses (hazard ratio: 0.235, P = .021; aHR: 0.218; 95% CI: 0.058‐0.822). TIL density similarly stratified risk in pathologically staged disease. Conclusions In patients with AJCC8 stage I disease, low TIL density was associated with diminished RFS. Our data suggest that assessing TIL density on H&E‐stained primary tumor specimens may enhance the prognostic resolution of the AJCC8 staging criteria for HPV‐OPC. Level of Evidence 4 Laryngoscope, 130:930–938, 2020

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“…HPV negativní dlaždicobuněčné karcinomy si zachovaly původní N klasifi- [67,72]. T status nadále přetrvává jako významný prediktor rekurence [77]. Několik dalších studií potvrdilo jako prognosticky nepříznivý faktor kouřenízejména více než 10 balíčkoroků.…”

Section: Změny V N Klasifikaciunclassified

Current Perspective on HPV-Associated Oropharyngeal Carcinomas and the Role of p16 as a Surrogate Marker of High-Risk HPV

Gurín¹,

Slavík²,

Shatokhina³

et al. 2019

Klin Onkol

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1 I. ústav patologie, LF MU a FN u sv. Anny v Brně 2 Klinika radiační onkologie, LF MU a Masarykův onkologický ústav, Brno 3 CEITEC -Středoevropský technologický institut, MU, Brno 4 Klinika komplexní onkologické péče, LF MU a Masarykův onkologický ústav, Brno SouhrnVýchodiska: Karcinomy orofaryngu asociované s lidským papilomavirem (human papillomavirus -HPV) nejen pro svou nadále vzrůstající incidenci představují významnou kapitolu v oblasti nádorů hlavy a krku. Tyto nádory oproti HPV negativním karcinomům orofaryngu disponují odlišnými epidemiologickými, klinickými i molekulárními vlastnostmi, lepší odpovědí na léčbu a prognózou. Vlivem těchto skutečností byla provedena celá řada studií, jejichž společným cílem bylo navržení adekvátního stagingového systému pro HPV asociované karcinomy orofaryngu, neboť 7. vydání American Joint Committee on Cancer nebralo v potaz unikátní bio logické chování tohoto onemocnění. Výsledkem jsou zásadní změny v TNM klasifikaci karcinomů orofaryngu, které jsou nyní v závislosti na expresi surogátního markeru high-risk HPV p16 členěny na p16 pozitivní a p16 negativní. Cíl: Cílem tohoto přehledového článku je nejen shrnutí aktuálních vědomostí o HPV asociovaných karcinomech orofaryngu s důrazem na jejich molekulární podklad a morfologii, ale také shrnutí a porovnání metod detekce viru HPV. Zároveň je diskutován prognostický význam exprese biomarkeru p16 u těchto nádorů. Součástí přehledového článku je dále představení změn ve stagingu karcinomů orofaryngu v závislosti na expresi markeru p16, vč. odůvodnění, která k těmto změnám vedla. SummaryBackground: The incidence of oropharyngeal carcinomas associated with human papillomavirus (HPV) is continuously increasing. HPV-positive and -negative oropharyngeal carcinomas have different epidemiological, clinical, and molecular features, with HPV-positive tumors having a better response to treatment and better prognosis. An adequate staging system for HPV-related oropharyngeal carcinomas is needed, as the American Joint Committee on Cancer 7 th Edition did not consider their unique bio logical behavior. At present, oropharyngeal carcinomas are subdivided into p16 positive and p16 negative tumors, based on their expression of p16, a surrogate marker of high--risk HPV. Purpose: This review summarizes current knowledge of HPV-associated oropharyngeal carcinomas with emphasis on their molecular features and histopathology, as well as summarizes and compares HPV detection methods and genotyping techniques. This review also describes the prognostic significance of p16 expression in these tumors and significant changes in the staging of oropharyngeal carcinomas based on p16 expression, together with the justifications for these changes.

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AJCC-8ed nodal staging does not predict outcomes in surgically managed HPV-associated oropharyngeal cancer

Cited by 22 publications

References 20 publications

Evaluating the impact of smoking on disease‐specific survival outcomes in patients with human papillomavirus–associated oropharyngeal cancer treated with transoral robotic surgery

Evaluating the impact of smoking on disease‐specific survival outcomes in patients with human papillomavirus–associated oropharyngeal cancer treated with transoral robotic surgery

Tumor‐infiltrating lymphocyte quantification stratifies early‐stage human papillomavirus oropharynx cancer prognosis

Current Perspective on HPV-Associated Oropharyngeal Carcinomas and the Role of p16 as a Surrogate Marker of High-Risk HPV

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