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).
pp. 827-833.
Text
Craig 2019 BJC_HPV status TNM8.pdf - Published version Download (598kB) |
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 |
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Uncontrolled Keywords: | head and neck cancer, prognostic markers |
Depositing User: | Symplectic Admin |
Date Deposited: | 29 Apr 2019 10:55 |
Last Modified: | 19 Jan 2023 00:53 |
DOI: | 10.1038/s41416-019-0414-9 |
Related URLs: | |
URI: | https://livrepository.liverpool.ac.uk/id/eprint/3038884 |