A review of the 8th edition of the AJCC staging system for oropharyngeal cancer according to HPV status
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REVIEW ARTICLE
A review of the 8th edition of the AJCC staging system for oropharyngeal cancer according to HPV status Piotr Machczyński1 · Ewa Majchrzak1 · Patryk Niewinski1 · Joanna Marchlewska1 · Wojciech Golusiński1 Received: 11 March 2020 / Accepted: 10 April 2020 © The Author(s) 2020
Abstract Background The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has increased substantially in recent decades, particularly p16-positive human papillomavirus (HPV)-related OPSCC, which has risen by 50% in western countries. HPV-positivity is the most favourable non-anatomic predictor of oropharyngeal cancer outcomes, which underscores the importance of incorporating this variable into the cancer staging system. Methods In the present article, we review the differences between the 7th and 8th editions of the AJCC staging system, with particular focus on the role of HPV-positivity in patients with head and neck cancer. Results In the previous edition (7th edition) of the AJCC/UICC manual, HPV status and its correlation with nodal metastasis were not considered, thereby leading to incorrect lymph node (N) staging and, potentially, inadequate treatment and worse outcomes. The 8th edition of the AJCC manual addresses these issues, providing more accurate discrimination between groups and better risk stratification in patients with HPV-positive OPSCC. In the future, additional adjustments are likely to be needed, such as unification of the pathological and clinical staging models. Conclusions The new staging system is substantially more accurate than the previous system and should be widely adopted in routine clinical practice. Keywords Oropharyngeal squamous cell carcinoma · HPV-related oropharyngeal cancer · AJCC staging system · TNM staging system
Introduction Oropharyngeal squamous cell carcinoma (OPSCC) is a common type of head and neck cancer. In 2018, nearly 93,000 patients were diagnosed with OPSCC, accounting for more than 13% of all head and neck cancers globally [1]. OPSCC has traditionally been associated with two main, synergistic risk factors, tobacco use and excessive alcohol consumption [2]. The main reason for the unremitting rise in the incidence of OPSCC in recent decades is human papillomavirus (HPV) infection [3]. Approximately 50% of OPSCC cases in western countries are HPV-positive, with higher rates in the United States and Scandinavia, and lower rates in Southern Europe [4]. Risk factors include: numerous oral and vaginal * Piotr Machczyński [email protected] 1
Head and Neck Surgery Department, The Greater Poland Cancer Centre, University of Medical Sciences Poznan, 15 Garbary St, 61‑866 Poznan, Poland
sexual partners, young age of sexual initiation, and in men a history of anogenital warts, all of which may lead to viral colonization of the oral and oropharyngeal mucosa. Immunocompromised patients, sexual partners of women with cervical cancer, and patients with a history of HPV-related anogenital cancer are at increased risk of acquiring HPVpositive head and neck cancer
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