Recommendations for determining HPV status in patients with oropharyngeal cancers under TNM8 guidelines: a two-tier approach
- Resource Type
- Authors
- Craig, Stephanie G; Anderson, Lesley A; Schache, Andrew G; Moran, Michael; Graham, Laura; Currie, Keith; Rooney, Keith; Robinson, Max; Upilet, Navdeep S; Brooker, Rachel; Mesri, Mina; Bingham, Victoria; McQuaid, Stephen; Jones, Terry; McCance, Dennis J; Salto-Tellez, Manuel; McDade, Simon S; James, Jacqueline A
- Source
- Craig, S, Anderson, L, Schache, A, Moran, M, Graham, L, Currie, K, Rooney, K, Robinson, M, Upile, N, Brooker, R, Mesri, M, Bingham, V, McQuaid, S, Jones, T, McCance, D, Salto-Tellez, M, McDade, S & James, J 2019, ' Recommendations for determining HPV status in patients with oropharyngeal cancers under TNM8 guidelines: a two-tier approach ', British Journal of Cancer, vol. 120, pp. 827–833 . https://doi.org/10.1038/s41416-019-0414-9
BRITISH JOURNAL OF CANCER
- Subject
- HPV
p16 IHC
Staging
SDG 3 - Good Health and Well-being
OPSCC
- Language
- English
BackgroundTNM8 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.MethodsHPV 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.ResultsTNM8 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.ConclusionGiven 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.