Recommendations for determining HPV status in patients with oropharyngeal cancers under TNM8 guidelines: a two-tier approach.
View/ Open
Date
2019-04-16ICR Author
Author
Craig, SG
Anderson, LA
Schache, AG
Moran, M
Graham, L
Currie, K
Rooney, K
Robinson, M
Upile, NS
Brooker, R
Mesri, M
Bingham, V
McQuaid, S
Jones, T
McCance, DJ
Salto-Tellez, M
McDade, SS
James, JA
Type
Journal Article
Metadata
Show full item recordAbstract
BACKGROUND: TNM8 staging for oropharyngeal squamous cell carcinomas (OPSCC) surrogates p16 immunohistochemistry for HPV testing. Patients with p16+ OPSCC may lack HPV aetiology. Here, we evaluate the suitability of TNM8 staging for guiding prognosis in such patients. METHODS: HPV status was ascertained using p16 immunohistochemistry and high-risk HPV RNA and DNA in situ hybridisation. Survival by stage in a cohort of OPSCC patients was evaluated using TNM7/TNM8 staging. Survival of p16+/HPV- patients was compared to p16 status. RESULTS: TNM8 staging was found to improve on TNM7 (log rank p = 0·0190 for TNM8 compared with p = 0·0530 for TNM7) in p16+ patients. Patients who tested p16+ but were HPV- (n = 20) had significantly reduced five-year survival (33%) compared to p16+ patients (77%) but not p16- patients (35%). Cancer stage was reduced in 95% of p16+/HPV- patients despite having a mortality rate twice (HR 2.66 [95% CI: 1.37-5.15]) that of p16+/HPV+ patients under new TNM8 staging criteria. CONCLUSION: Given the significantly poorer survival of p16+/HPV- OPSCCs, these data provide compelling evidence for use of an HPV-specific test for staging classification. This has particular relevance in light of potential treatment de-escalation that could expose these patients to inappropriately reduced treatment intensity as treatment algorithms evolve.
Collections
Subject
Humans
Papillomavirus Infections
Oropharyngeal Neoplasms
Viral Proteins
Neoplasm Staging
Disease-Free Survival
Gene Expression Regulation, Neoplastic
Adolescent
Adult
Middle Aged
Child
Child, Preschool
Infant
Infant, Newborn
Female
Male
Young Adult
Research team
Integrated Pathology
Language
eng
Date accepted
2019-02-06
License start date
2019-04
Citation
British journal of cancer, 2019, 120 (8), pp. 827 - 833
Publisher
SPRINGERNATURE