Prognostic Impact of AJCC/UICC 8th Edition New Staging Rules in Oropharyngeal Squamous Cell Carcinoma
IntroductionThe purpose of this study was to test whether the 8th edition of the AJCC/UICC TNM staging system (UICC) precisely differentiates between stages and reflects disease outcome in human papilloma virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC).Patients and methodsOPSCC...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2017-06-01
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| Series: | Frontiers in Oncology |
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| Online Access: | http://journal.frontiersin.org/article/10.3389/fonc.2017.00129/full |
| _version_ | 1828516949903015936 |
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| author | Nora Würdemann Steffen Wagner Shachi Jenny Sharma Elena-Sophie Prigge Miriam Reuschenbach Stefan Gattenlöhner Jens Peter Klussmann Claus Wittekindt |
| author_facet | Nora Würdemann Steffen Wagner Shachi Jenny Sharma Elena-Sophie Prigge Miriam Reuschenbach Stefan Gattenlöhner Jens Peter Klussmann Claus Wittekindt |
| author_sort | Nora Würdemann |
| collection | DOAJ |
| description | IntroductionThe purpose of this study was to test whether the 8th edition of the AJCC/UICC TNM staging system (UICC) precisely differentiates between stages and reflects disease outcome in human papilloma virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC).Patients and methodsOPSCC patients that were diagnosed between 2000 and 2016 were included in this analysis and HPV status was determined by combined DNA and p16 testing. Stratification was done according to 7th and 8th UICC staging rules. Incidence trends of HPV-associated tumorigenesis, 5-year overall survival (OS) according to tumor stages as well as the influence of therapy and prognostic factors toward the outcome were calculated using Kaplan–Meier method and Cox proportional-hazards model.ResultsA significant increase [2000; n = 8/39 (21%)–2015; n = 17/32 (53%); p = 0.002] in HPV-associated OPSCC was seen in the observation period. Together, 150/599 (25.0%) of the patients had HPV-driven OPSCC and 64.7% of curative treatments in all OPSCC patients included upfront surgery of the primary and the neck. 7th edition staging rules led to no discrimination in all respective four UICC stages in HPV OPSCC underlining the need for new staging rules. However, only discrimination between stages I vs. II and III vs. IV was significant in our patients with HPV-OPSCC (94.4 vs. 77.5%; p = 0.031 and 63.9 vs. 25.0%; p = 0.013), and stages II vs. III did not differ in OS rates (p = 0.257), when applying the new staging rules. For HPV-negative OPSCC, significant outcome differences were only seen between UICC stages III vs. IV (57.6 vs. 35.2%; p = 0.012).DiscussionWhile the 7th edition of UICC shows invalid discrimination between stages, the 8th edition is more suitable for HPV-associated carcinoma. Due to lack of differentiation between stages II and III further adaption is essential. |
| first_indexed | 2024-12-11T18:34:02Z |
| format | Article |
| id | doaj.art-f2821c0905fd4f6cae6cc7c3b50f5dc9 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-11T18:34:02Z |
| publishDate | 2017-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-f2821c0905fd4f6cae6cc7c3b50f5dc92022-12-22T00:54:49ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2017-06-01710.3389/fonc.2017.00129269772Prognostic Impact of AJCC/UICC 8th Edition New Staging Rules in Oropharyngeal Squamous Cell CarcinomaNora Würdemann0Steffen Wagner1Shachi Jenny Sharma2Elena-Sophie Prigge3Miriam Reuschenbach4Stefan Gattenlöhner5Jens Peter Klussmann6Claus Wittekindt7Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen, Giessen, GermanyDepartment of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen, Giessen, GermanyDepartment of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen, Giessen, GermanyDepartment of Applied Tumor Biology, University of Heidelberg, Heidelberg, GermanyDepartment of Applied Tumor Biology, University of Heidelberg, Heidelberg, GermanyInstitute of Pathology, University of Giessen, Giessen, GermanyDepartment of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen, Giessen, GermanyDepartment of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen, Giessen, GermanyIntroductionThe purpose of this study was to test whether the 8th edition of the AJCC/UICC TNM staging system (UICC) precisely differentiates between stages and reflects disease outcome in human papilloma virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC).Patients and methodsOPSCC patients that were diagnosed between 2000 and 2016 were included in this analysis and HPV status was determined by combined DNA and p16 testing. Stratification was done according to 7th and 8th UICC staging rules. Incidence trends of HPV-associated tumorigenesis, 5-year overall survival (OS) according to tumor stages as well as the influence of therapy and prognostic factors toward the outcome were calculated using Kaplan–Meier method and Cox proportional-hazards model.ResultsA significant increase [2000; n = 8/39 (21%)–2015; n = 17/32 (53%); p = 0.002] in HPV-associated OPSCC was seen in the observation period. Together, 150/599 (25.0%) of the patients had HPV-driven OPSCC and 64.7% of curative treatments in all OPSCC patients included upfront surgery of the primary and the neck. 7th edition staging rules led to no discrimination in all respective four UICC stages in HPV OPSCC underlining the need for new staging rules. However, only discrimination between stages I vs. II and III vs. IV was significant in our patients with HPV-OPSCC (94.4 vs. 77.5%; p = 0.031 and 63.9 vs. 25.0%; p = 0.013), and stages II vs. III did not differ in OS rates (p = 0.257), when applying the new staging rules. For HPV-negative OPSCC, significant outcome differences were only seen between UICC stages III vs. IV (57.6 vs. 35.2%; p = 0.012).DiscussionWhile the 7th edition of UICC shows invalid discrimination between stages, the 8th edition is more suitable for HPV-associated carcinoma. Due to lack of differentiation between stages II and III further adaption is essential.http://journal.frontiersin.org/article/10.3389/fonc.2017.00129/fulloropharyngeal cancersurgeryhuman papilloma virusprognosishead and neck cancerUICC 7 |
| spellingShingle | Nora Würdemann Steffen Wagner Shachi Jenny Sharma Elena-Sophie Prigge Miriam Reuschenbach Stefan Gattenlöhner Jens Peter Klussmann Claus Wittekindt Prognostic Impact of AJCC/UICC 8th Edition New Staging Rules in Oropharyngeal Squamous Cell Carcinoma Frontiers in Oncology oropharyngeal cancer surgery human papilloma virus prognosis head and neck cancer UICC 7 |
| title | Prognostic Impact of AJCC/UICC 8th Edition New Staging Rules in Oropharyngeal Squamous Cell Carcinoma |
| title_full | Prognostic Impact of AJCC/UICC 8th Edition New Staging Rules in Oropharyngeal Squamous Cell Carcinoma |
| title_fullStr | Prognostic Impact of AJCC/UICC 8th Edition New Staging Rules in Oropharyngeal Squamous Cell Carcinoma |
| title_full_unstemmed | Prognostic Impact of AJCC/UICC 8th Edition New Staging Rules in Oropharyngeal Squamous Cell Carcinoma |
| title_short | Prognostic Impact of AJCC/UICC 8th Edition New Staging Rules in Oropharyngeal Squamous Cell Carcinoma |
| title_sort | prognostic impact of ajcc uicc 8th edition new staging rules in oropharyngeal squamous cell carcinoma |
| topic | oropharyngeal cancer surgery human papilloma virus prognosis head and neck cancer UICC 7 |
| url | http://journal.frontiersin.org/article/10.3389/fonc.2017.00129/full |
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