New York University School of Medicine, New York, New York.
Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.
Cancer Epidemiol Biomarkers Prev. 2022 Aug 2;31(8):1554-1563. doi: 10.1158/1055-9965.EPI-21-0776.
The updated American Joint Committee on Cancer (AJCC) 8th Edition staging manual restructured nodal classification and staging by placing less prognostic emphasis on nodal metastases for human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). However, there was no change for HPV-negative OPSCC. The purpose of our study is to examine the impact of nodal metastases on survival in HPV-negative OPSCC.
HPV-negative OPSCC was queried from the National Cancer Database (NCDB) and Surveillance, Epidemiology and End Results program (SEER) databases. Univariable and multivariable models were utilized to determine the impact of nodal status on overall survival. These patients were reclassified according to AJCC 8 HPV-positive criteria (TNM8+) and risk stratification was quantified with C-statistic.
There were 11,147 cases of HPV-negative OPSCC in the NCDB and 3,613 cases in SEER that were included in the nodal classification analysis. Unlike nonoropharyngeal malignancies, increased nodal stage is not clearly associated with survival for patients with OPSCC independent of HPV status. When the TNM8+ was applied to HPV-negative patients, there was improved concordance in the NCDB cohort, 0.561 (plus minus) 0.004 to 0.624 (plus minus) 0.004 (difference +0.063) and the SEER cohort, 0.561 (plus minus) 0.008 to 0.625 (plus minus) 0.008 (difference +0.065).
We demonstrated a reduced impact of nodal metastasis on OPSCC survival, independent of HPV status and specific to OPSCC.
We demonstrate, for the first time that when nodal staging is deemphasized as a part of overall staging, we see improved concordance and risk stratification for HPV-negative OPSCC. The exact mechanism of this differential impact remains unknown but offers a novel area of study.
新版美国癌症联合委员会（AJCC）第 8 版分期手册通过降低 HPV 阳性口咽鳞状细胞癌（OPSCC）的淋巴结转移对预后的影响，重新构建了淋巴结分类和分期。然而，对于 HPV 阴性 OPSCC 并没有改变。我们的研究目的是检验淋巴结转移对 HPV 阴性 OPSCC 生存的影响。
从国家癌症数据库（NCDB）和监测、流行病学和最终结果计划（SEER）数据库中查询 HPV 阴性 OPSCC。采用单变量和多变量模型来确定淋巴结状态对总生存的影响。根据 AJCC 第 8 版 HPV 阳性标准（TNM8+）重新分类这些患者，并使用 C 统计量对风险分层进行量化。
NCDB 中有 11147 例 HPV 阴性 OPSCC 和 SEER 中有 3613 例病例纳入淋巴结分类分析。与非口咽恶性肿瘤不同，HPV 状态独立于 OPSCC 患者的淋巴结分期增加与生存无关。当 TNM8+应用于 HPV 阴性患者时，NCDB 队列的一致性得到改善，从 0.561（加减）0.004 提高到 0.624（加减）0.004（差异+0.063），SEER 队列的一致性从 0.561（加减）0.008 提高到 0.625（加减）0.008（差异+0.065）。
我们证明了淋巴结转移对 OPSCC 生存的影响降低，与 HPV 状态无关，且特定于 OPSCC。
我们首次证明，当淋巴结分期作为总体分期的一部分被淡化时，我们看到 HPV 阴性 OPSCC 的一致性和风险分层得到改善。这种差异影响的确切机制尚不清楚，但提供了一个新的研究领域。
