title: Population-based validation of the recursive partitioning analysis-based staging system for oropharyngeal cancer.
abstract: The American Joint Committee on Cancer (AJCC) staging system does not adequately distinguish prognostic groups in the era of human papillomavirus (HPV)-related oropharyngeal cancer. The purpose of this study was to validate a recursive partitioning analysis (RPA)-based stage grouping on a population-wide level.
  
  
  
  We identified 8427 patients in Surveillance, Epidemiology, and End Results (SEER) with nonmetastatic oropharyngeal cancer with unknown HPV-status diagnosed from 2004 to 2008. We estimated the overall survival (OS) and head and neck cancer-specific mortality by RPA stage and AJCC stage and compared the predictive power of the systems.
  
  
  
  RPA stage was significantly associated with OS and head and neck cancer-specific mortality (p < .0001) with 5-year OS of 70% for RPA-I, 55.6% for RPA-II, and 44.3% for RPA-III. AJCC stage failed to divide patients into distinct subgroups. RPA stage had significantly improved predictive ability versus AJCC stage for OS (c-statistic: 0.60 = RPA vs 0.54 = AJCC) and head and neck cancer-specific mortality (c-statistic: 0.62 = RPA vs 0.55 = AJCC).
  
  
  
  The RPA-based stage grouping divided patients into prognostically distinct cohorts and provided superior prediction of OS and head and neck cancer-specific mortality compared to AJCC staging. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1538, 2016.
authors.affiliation: Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts.
authors.forename: Florence K
authors.initials: FK
authors.lastname: Keane
authors.affiliation: Dana-Farber/Harvard Cancer Center, Boston, Massachusetts.
authors.forename: Yu-Hui
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Roy B
authors.initials: RB
authors.lastname: Tishler
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Schoenfeld
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Robert I
authors.initials: RI
authors.lastname: Haddad
authors.affiliation: Division of Otolaryngology, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Goguen
authors.affiliation: Dana-Farber/Harvard Cancer Center, Boston, Massachusetts.
authors.forename: Paul
authors.initials: P
authors.lastname: Catalano
authors.affiliation: Ariadne Labs, Boston, Massachusetts.
authors.forename: Bridget A
authors.initials: BA
authors.lastname: Neville
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts. dmargalit@lroc.harvard.edu.
authors.forename: Danielle N
authors.initials: DN
authors.lastname: Margalit
mesh_terms: D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology*; D027383:Papillomaviridae; D011379:Prognosis; D016016:Proportional Hazards Models; D018426:SEER Program
keywords: American Joint Committee on Cancer (AJCC) staging system; head and neck cancer staging; human papillomavirus (HPV)-related cancer; oropharyngeal squamous cell cancer; recursive partitioning analysis-based staging