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Prognostic significance of OPSCC tumor stage has increased over time
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The prognostic significance of nodal stage has decreased over time whereas the impact of tumor stage has increased for patients with oropharyngeal squamous cell carcinoma, according to the results of a SEER analysis.
These changes may reflect the increasing incidence of HPV-related oropharyngeal squamous cell carcinoma (OPSCC), according to the researchers.
Nodal stage has been the predominant prognostic factor for OPSCC; however, previous studies have suggested that HPV impacts the prognostic significance of tumor stage, according to study background.
Danielle N. Margalit, MD, MPH, of the department of radiation oncology at Dana-Farber Cancer Institute, and colleagues evaluated changes in the prognostic significance of nodal stage and tumor stage in the era of increasing HPV prevalence.
Researchers used the SEER database to identify 13,328 patients diagnosed with OPSCC between 1997 and 2008 who had nodal and tumor stage information available. The median age of the population was 58 years (range, 21-96) and 81% were male.
During a median follow-up of 67 months, 4,099 patients died from head and neck cancer.
Researchers noted there were statistically significant changes in the distribution of tumor and nodal stages over time. The incidence of T4 tumors decreased, whereas the incidence of T1 and T2 tumors increased (P = .002). There were fewer cases of node-negative tumors, which corresponding with an increase in N1 and N2a tumors over time (P = .002).
Tumor stage and nodal stage were significantly associated with head and neck cancer-specific mortality in adjusted analyses. Tumor stage had a linear link with head and neck cancer-specific mortality (P < .0001); however, the relationship between nodal stage and head and neck cancer-specific mortality was nonlinear, and patients with N2a disease demonstrated the lowest risk for cancer-specific mortality.
Researchers noted the difference in risk across node-negative to N3 nodal stages was modest (HR = 1.7; 95% CI, 1.48-1.94), whereas there was a strong difference in risk across T1 to T4 tumor stages (HR = 3; 95% CI, 2.71-3.31).
The impact of tumor stage on head and neck cancer-specific mortality increased over time and this linkage was significantly associated with year of diagnosis (P = .014).
The interaction between nodal stage and head and neck cancer-specific mortality also was significantly associated with year of diagnosis (P = .0004). The adjusted HRs for head and neck cancer-specific mortality stratified by N2a, N2b and N2c nodal stage all decreased in comparison with node-negative disease between 1997 and 2008.
Head and neck cancer-specific survival increased across all stages for patients diagnosed from 2004 to 2008 vs. those diagnosed between 1997 and 2003. However, researchers noted the American Joint Committee on Cancer stage did not distinguish prognostic subgroups by overall stage.
The researchers acknowledged their inability to ascertain HPV status and treatment details as a limitation of their study.
“These findings likely reflect the changing demographics of OPSCC and support current efforts to update the American Joint Committee on Cancer staging system for oropharynx cancer,” Margalit and colleagues concluded. – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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