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Recommendations for determining HPV status in patients with oropharyngeal cancers under TNM8 guidelines: a two-tier approach
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Recommendations for determining HPV status in patients with oropharyngeal cancers under TNM8 guidelines: a two-tier approach
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Journal Article
Recommendations for determining HPV status in patients with oropharyngeal cancers under TNM8 guidelines: a two-tier approach
2019
Overview
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.
Publisher
Nature Publishing Group UK,Nature Publishing Group
Subject
/ Adult
/ Biomedical and Life Sciences
/ Cancer
/ Child
/ DNA
/ Female
/ Gene Expression Regulation, Neoplastic - genetics
/ Humans
/ Infant
/ Male
/ Oncology
/ Oropharyngeal Neoplasms - genetics
/ Oropharyngeal Neoplasms - mortality
/ Oropharyngeal Neoplasms - pathology
/ Oropharyngeal Neoplasms - virology
/ Oropharyngolaryngeal carcinoma
/ Papillomavirus Infections - genetics
/ Papillomavirus Infections - pathology
/ Papillomavirus Infections - virology
/ Patients
/ RNA
