HPV-related OPC: how do 8th-edition AJCC guidelines affect staging of TORS patients?

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  • In a retrospective study, 94% of patients with human papillomavirus (HPV)-positive oropharyngeal cancer (OPC) treated with transoral robotic surgery (TORS) are stage I under the 8th edition American Joint Committee on Cancer (AJCC) staging system vs just 5% under 7th edition guidelines.

Why this matters

  • HPV-positive patients generally have better prognosis than HPV-negative patients; the 8th edition guidelines are the first to take HPV status into account.

Key results

  • OS was 100% (median 54 mo follow-up); estimated 3-y DFS was 87%.
  • Under 7th edition guidelines with pathologic data, 5% of patients were stage I, 11% were stage II, 26% were stage III, 57% were stage IVa, and 1% were stage IVb.
  • Under 8th edition guidelines, 94% of patients were stage I and 6% were stage II.
  • Under 7th edition guidelines, 25% of patients were upstaged and 14% were downstaged on final pathology after surgery.
  • Under 8th edition guidelines, 6% of patients were upstaged (P<.001 vs 7th edition) and 6% were downstaged (P=.0101 vs 7th edition) on final pathology.

Study design

  • 110 patients with HPV-positive OPC treated with TORS were analyzed for survival outcomes and staging by 7th and 8th edition AJCC guidelines.
  • Funding: None disclosed.


  • Retrospective study.