title: Tumor Staging and HPV-Related Oropharyngeal Cancer.
abstract: The current TNM staging for oropharyngeal cancer (OSCC) was designed empirically for non-HPV-related disease. Emerging evidence suggests it is unsuited for Human papillomavirus (HPV)-related OSCC. Patients with HPV-positive tumors have improved prognosis, despite presenting at advanced stages. These shortcomings of the current staging system have been identified in single- and multi-institutional trials. Patients with HPV related OSCC typically present with advanced N-stages leading to higher stage groupings. A rarity of stages I and II therefore represents the nature of HPV-related OSCC. Concerning prognosis of the patients, N-category and extracapsular spread seem to be of minor importance, whereas advanced T-stages result in unfavourable outcome. Anatomical staging therefore has been implied into different proposals to prognostic risk classifications in HPV-related disease as an additive compound. Prognostic risk groupings are further enhanced by incorporating non-anatomical factors. To summarize, it can be suggested that the current TNM system alone has little prognostic value in HPV-related OSCC.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany. claus.wittekindt@hno.med.uni-giessen.de.
authors.forename: Claus
authors.initials: C
authors.lastname: Wittekindt
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany.
authors.forename: Jens Peter
authors.initials: JP
authors.lastname: Klussmann
mesh_terms: D006801:Humans; D009367:Neoplasm Staging / Q000379:methods; D009959:Oropharyngeal Neoplasms / Q000473:pathology* / Q000821:virology*; D027383:Papillomaviridae / Q000472:pathogenicity; D030361:Papillomavirus Infections / Q000473:pathology* / Q000821:virology*; D011379:Prognosis
keywords: HPV; Oropharyngeal Cancer; Prognosis; Risk Groupings; Staging