Who is WIll Rogers?
The Study: Most notable among the changes in pathologic staging was the incorporation of the number of nodes involved in lieu of the presence of extracapsular extension (ECE). This study aims to better characterize low, intermediate, and high risk resected HPV(+) oropharyngeal cancer. Traditionally, as founded in RTOG 9501 and EORTC 2293, low risk resected disease has been defined as negative margins (>5 mm) with ≤1 node involved; intermediate risk as the presence of LVSI, PNI, close margins (≤5 mm), or ≥2 nodes involved; and high risk as the presence of ECE or involved margins. Here the authors build off emerging data specific to outcomes with HPV(+) disease in an NCDB cohort to create a new risk stratification model based on an additive point-system (table 1 is a must-see). They then put this new model to the test in a retrospective fashion on >15K patients with resected H&N cancer in the NCDB. First, the traditional risk stratification was confirmed to be bad. Survival rates at 5 years for high / intermediate / low risk disease were 76% / 55% / 41% for HPV(-), n=13K, and 93% / 89% / 84% for HPV(+) disease, n=2300—we hear ya, Will Rogers. Using the new point-based stratification on HPV(+) disease, the proportion classified as “high risk” decreased from a whopping 46% to only 7%, and survival rates at 5 years were much better discriminated at 92% / 83% / 53%.
Bottom Line: Traditional pathologic risk stratification of HPV(+) oropharyngeal cancer needs an overhaul. | Cramer, JAMA Otolaryngol Head Neck Surg 2019