Comparison of the Seventh and Eighth Edition of American Joint Committee on Cancer (AJCC) Staging for Selected and Nonselected Oropharyngeal Squamous Cell Carcinomas

• Type of Material: Article
• Authors: Pooja Vijayvargiya, Emory University; Sumita Trivedi, Emory University; Manali Rupji, Emory University; Hoacan Song, Emory University; Yuan Liu, Emory University; Renjian Jiang, Emory University; Azeem Kaka, Emory University; Georgia Chen, Emory University; William Stokes, Emory University; Conor Steuer, Emory University; Dong Shin, Emory University; Jonathan Beitler, Emory University; Mihir Patel, Emory University; Ashley Aiken, Emory University; Nabil Saba, Emory University
• Language: English
• Date: 2022-02-03
• Publisher: Oxford University Press
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022. Published by Oxford University Press.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/oncolo/oyab001
• Title of Journal or Parent Work: The Oncologist
• Volume: 27
• Issue: 1
• Start Page: 48
• End Page: 56
• Grant/Funding Information: Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292.
• Keywords: Trends; Head; HPV; Epidemiology; Human papillomavirus; oropharyngeal squamous cell carcinoma; Icon-S; human papilloma virus; disease-specific survival; TNM; Life Sciences & Biomedicine; Validation; Science & Technology; AJCC; overall survival; staging; Oncology; SEER; Survival
• Research Categories: Health Sciences, Oncology; Biology, Virology; Health Sciences, Radiology; Biology, Biostatistics

Abstract

Objectives The eighth edition American Joint Committee on Cancer (AJCC) Staging incorporates significant changes to the seventh edition in the staging of oropharyngeal squamous cell carcinomas (OPSCC). An important change was the inclusion of OPSCC associated with the human papilloma virus (HPV). Our goal is to compare the performance of both staging systems for patients with HPV-selected and unselected clinical characteristics for OPSCC. Methods Using the Surveillance, Epidemiology, and End Results (SEER) database, 2004-2016, we identified patients with likely HPV-associated OPSCC based on surrogate markers (white males aged <65 years old with squamous cell carcinomas of the tonsil and base of tongue), excluding those who underwent surgery. We re-classified these patients using seventh and eighth edition staging for HPV-selected OPSCC and compared the prediction performance of both staging editions for overall survival (OS) and disease-specific survival (DSS). We performed the same analysis for clinically unselected patients with OPSCC. Results Our analysis included 9554 patients with a median follow-up of 67 months. Comparing the eighth versus seventh edition for our HPV-selected cohort, clinical staging changed for 92.3% of patients and 10-year OS was 62.2%, 61.2%, 35.3%, and 15.5% for Stage I, II, III, and IV, versus 52.9%, 59.2%, 61.6%, 55.1%, 38.3%, and 15.5% for stage I, II, III, IVA, IVB, and IVC, respectively. A similar pattern was observed for 10-year DSS. The concordance statistics for our HPV-selected cohort were improved for both AJCC 7 (0.6260) and AJCC 8 (0.6846) compared with the unselected cohort, 0.5860 and 0.6457 for AJCC 7 and 8, respectively. Conclusion The overall performance of discrimination improved from AJCC 7 to AJCC 8 for both clinically selected and unselected patients, but more notably for our HPV-selected cohort. Despite the lack of statistically significant differentiation between Stages I and II in AJCC 8 in either groups, markedly improved discrimination was observed between Stages I/II, III, and IV in the HPV-selected cohort.