title: Staging and treatment of oropharyngeal cancer in the human papillomavirus era.
abstract: BACKGROUND
  Oropharyngeal squamous cell carcinoma (SCC) is staged using the TNM system. Human papillomavirus (HPV)-positive tumors have improved prognosis, despite presenting at advanced stage. Optimal treatment and stratification of HPV-positive patients are not clearly defined.
  
  
  METHODS
  We retrospectively analyzed 266 patients with oropharyngeal SCC for mortality and feeding tube dependency related to TNM stage, HPV status, and treatment.
  
  
  RESULTS
  TNM staging was prognostic in HPV-negative patients (stage III/IV hazard ratio [HR], 2.00; p = .05; N(+) HR, 2.19; p = .02). Only T classification was prognostic in HPV-positive tumors (T3/T4 HR 3.31; p = .006). HPV-positive tumors showed improved survival regardless of treatment. Patients receiving chemotherapy had a significantly increased risk of feeding tube dependency (odds ratio [OR], 1.72; p = .03).
  
  
  CONCLUSIONS
  These data suggest that the current TNM system has little prognostic value in HPV-positive oropharyngeal SCC. Patients with HPV-positive tumors show improved survival independent of treatment. The addition of chemotherapy increases the risk of feeding tube dependency and could potentially be avoided in T1/T2 HPV-positive tumors without compromising survival.
authors.affiliation: Cancer Sciences Unit, University of Southampton, United Kingdom.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Ward
authors.affiliation: Cancer Sciences Unit, University of Southampton, United Kingdom.
authors.forename: Toby
authors.initials: T
authors.lastname: Mellows
authors.affiliation: Department of Medical Statistics, University of Southampton, United Kingdom.
authors.forename: Scott
authors.initials: S
authors.lastname: Harris
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Southampton NHS Foundation Trust, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Webb
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University Hospital Southampton NHS Foundation Trust, United Kingdom.
authors.forename: Nimesh N
authors.initials: NN
authors.lastname: Patel
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Poole NHS Foundation Trust, United Kingdom.
authors.forename: Hugh J
authors.initials: HJ
authors.lastname: Cox
authors.affiliation: Department of Cellular Pathology, Bart's and The London School of Medicine and Dentistry, United Kingdom.
authors.forename: Kim
authors.initials: K
authors.lastname: Piper
authors.affiliation: Cancer Sciences Unit, University of Southampton, United Kingdom.|NIHR Experimental Cancer Medicine Centre Southampton, United Kingdom.
authors.forename: Christian H
authors.initials: CH
authors.lastname: Ottensmeier
authors.affiliation: Cancer Sciences Unit, University of Southampton, United Kingdom.|NIHR Experimental Cancer Medicine Centre Southampton, United Kingdom.
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Thomas
authors.affiliation: Cancer Sciences Unit, University of Southampton, United Kingdom.|Department of Otolaryngology - Head and Neck Surgery, Poole NHS Foundation Trust, United Kingdom.|NIHR Experimental Cancer Medicine Centre Southampton, United Kingdom.
authors.forename: Emma V
authors.initials: EV
authors.lastname: King
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000628:therapy / Q000821:virology; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000628:therapy / Q000821:virology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology* / Q000628:therapy / Q000821:virology; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications*; D011379:Prognosis; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: TNM staging; human papillomavirus (HPV); oropharyngeal cancer