HPV Infection in Head and Neck Cancer

Tumor Staging and HPV-Related Oropharyngeal Cancer

HPV Infection in Head and Neck Cancer

Recent results in cancer research Fortschritte der Krebsforschung Progrès dans les recherches sur le cancer, October 2016

27699534

978-3-31-943578-7, 978-3-31-943580-0

Claus Wittekindt, Jens Peter Klussmann

Wojciech Golusiński, C. René Leemans, Andreas Dietz

The current TNM staging for oropharyngeal cancer (OSCC) was designed empirically for non-HPV-related disease. Emerging evidence suggests it is unsuited for Human papillomavirus (HPV)-related OSCC. Patients with HPV-positive tumors have improved prognosis, despite presenting at advanced stages. These shortcomings of the current staging system have been identified in single- and multi-institutional trials. Patients with HPV related OSCC typically present with advanced N-stages leading to higher stage groupings. A rarity of stages I and II therefore represents the nature of HPV-related OSCC. Concerning prognosis of the patients, N-category and extracapsular spread seem to be of minor importance, whereas advanced T-stages result in unfavourable outcome. Anatomical staging therefore has been implied into different proposals to prognostic risk classifications in HPV-related disease as an additive compound. Prognostic risk groupings are further enhanced by incorporating non-anatomical factors. To summarize, it can be suggested that the current TNM system alone has little prognostic value in HPV-related OSCC.