Recommendations for determining HPV status in patients with oropharyngeal cancers under TNM8 guidelines: a two-tier approach



Craig, Stephanie G, Anderson, Lesley A, Schache, Andrew G ORCID: 0000-0001-9466-6038, Moran, Michael, Graham, Laura, Currie, Keith, Rooney, Keith, Robinson, Max, Upilet, Navdeep S, Brooker, Rachel ORCID: 0000-0002-0668-6889
et al (show 8 more authors) (2019) Recommendations for determining HPV status in patients with oropharyngeal cancers under TNM8 guidelines: a two-tier approach. BRITISH JOURNAL OF CANCER, 120 (8). 827 - 833.

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Abstract

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.

Item Type: Article
Uncontrolled Keywords: head and neck cancer, prognostic markers
Depositing User: Symplectic Admin
Date Deposited: 29 Apr 2019 10:55
Last Modified: 02 Dec 2021 08:22
DOI: 10.1038/s41416-019-0414-9
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3038884