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Application of the Eighth Edition A merican J oint C ommittee on C ancer Staging System for HPV ‐Related Oropharyngeal Cancer Treated With Transoral Robotic Surgery
Author(s) -
Badhey Arvind K.,
Olson Ashley,
Kadakia Sameep,
Russo Jack,
Ting Peter,
Khalid Mian,
Yao Mike,
Teng Marita S.,
Genden Eric M.,
Miles Brett A.,
Chai Raymond L.
Publication year - 2018
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26948
Subject(s) - medicine , stage (stratigraphy) , cancer , context (archaeology) , cohort , confidence interval , oncology , adjuvant , radiation therapy , surgery , paleontology , biology
Objective Analyze patients treated with transoral robotic surgery (TORS) in the context of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system. Methods Retrospective cohort study including 110 human papillomavirus‐related oropharyngeal cancer (HPV+OPC) patients with a minimum 1‐year follow‐up treated with TORS between 2007 to 2016. Kaplan‐Meier methods were used to estimate 3‐year disease‐free survival and assess differences in recurrence. Results One hundred and ten patients with a median follow‐up of 54 months were analyzed. Of those, 85% of patients were male, with a median age of 60. Twenty‐two percent of patients received no adjuvant therapy; 43% received adjuvant radiation; and 35% underwent adjuvant chemoradiation. Extracapsular spread was identified in 24% of patients. Overall survival was 100%, with estimated 3‐year disease‐free survival (DFS) (95% confidence interval) of 87% (77, 93). Under the seventh edition of the AJCC, 5% of patients were stage I; 11% were stage II; 26% were stage III; and 57% were stage IVa. Twenty‐seven patients (25%) were upstaged on final pathology, whereas 15 patients (14%) were downstaged. Under the eighth edition of the AJCC, 94% of patients were stage I for both clinical and pathologic staging systems. Six patients (6%) were upstaged on final pathology, whereas six patients (6%) were downstaged. No factors demonstrated statistical significance for DFS. Within pathologic stage I, Kaplan‐Meier estimates for DFS did not reach statistical significance. Conclusion The majority of patients undergoing TORS for HPV + OPC are stage I under the eighth edition of the AJCC staging system, with limited pathologic re‐staging compared with the prior system. Oncologic outcomes are favorable for this group. No clinicopathologic features are significant for DFS within pathologic stage I. Level of Evidence 2b. Laryngoscope , 128:1133–1139, 2018