Staging HPV-related oropharyngeal cancer: Validation of AJCC-8 in a surgical cohort

Mathew Geltzeiler, Marnie Bertolet, William Greer Albergotti, John Gleysteen, Brennan Olson, Michael Persky, Neil Gross, Ryan Li, Peter Andersen, Seungwon Kim, Robert L. Ferris, Umamaheswar Duvvuri, Daniel Clayburgh

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Importance: The American Joint Committee on Cancer, 8th edition (AJCC-8) contains a new staging system for human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). Our study aim was to evaluate the effectiveness of the AJCC-8 relative to the AJCC 7th edition (AJCC-7). Materials and methods: A retrospective chart review was performed on a multi-institutional, prospectively collected dataset from two tertiary referral centers. All patients had HPV+ OPSCC treated primarily with surgery. The prognostic value of AJCC-7 and AJCC-8 were compared for 5-year overall survival (OS) and disease-specific survival (DFS). Results: AJCC-8 pathological staging effectively risk stratified patients, creating a Cox model with a better fit (lower Akaike's Information Criterion, p < 0.0001) when compared to AJCC-7 pathological stages for both OS and DFS. The AJCC-8 pathologic staging did not produce a better fit than the AJCC-8 clinical staging (p = 0.15) for OS, however, AJCC-8 pathologic was more effective than AJCC-8 clinical for DFS (p < 0.0001). 76% of patients did not change their stage between clinical and pathologic AJCC-8 staging; 14% were upstaged by 1, <1% were upstaged by 2, 7% were downstaged by 1, and 3% downstaged by 2. Conclusions and relevance: The new AJCC-8 staging system represents a significant improvement over AJCC-7 for risk stratification into groups that predict overall survival and disease-specific survival of surgically treated HPV+ OPSCC patients. The AJCC- 8 pathologic staging system was not significantly better than the AJCC-8 clinical staging system for overall survival, however, the pathologic staging system was better than the clinical for disease free survival.

Original languageEnglish (US)
Pages (from-to)82-87
Number of pages6
JournalOral Oncology
StatePublished - Sep 2018


  • AJCC
  • American joint committee on cancer
  • Cancer staging
  • HPV
  • Human papilloma virus
  • Oropharyngeal cancer
  • Oropharyngeal squamous cell carcinoma

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research


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