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Updated Guidance Improves Staging of HPV-Positive Oropharyngeal Cancer

By Elana Gotkine HealthDay Reporter

Posted on July 2025

Medically reviewed by Carmen Pope, BPharm. Last updated on July 21, 2025.

MONDAY, July 21, 2025 -- Version nine of the American Joint Committee on Cancer (AJCC) and Union for International Cancer Control staging system (AJCC9V) human papillomavirus (HPV)-positive oropharyngeal carcinoma staging classification offers improved prognostication and management compared with the eighth edition (AJCC8E), according to a multicenter registry analysis published online July 8 in The Lancet Oncology.

Allen S. Ho, M.D., from Cedars-Sinai Medical Center in Los Angeles, and colleagues divided U.S. registry data from the National Cancer Database into derivation and validation cohorts in order to reappraise HPV-positive oropharyngeal carcinoma pathological staging. A total of 14,447 adult patients across 984 facilities in the United States met the inclusion criteria and were divided into a derivation cohort and validation cohort (7,768 and 6,679 patients, respectively); patients were followed for a median of 52.4 months.

The researchers found that with each additional metastatic lymph node, mortality risk increased (hazard ratio, 1.20), up to an optimal cutoff of 4.3 lymph nodes. The association of pathological extranodal extension (pENE) with increased mortality risk was confirmed in multivariable analysis (hazard ratio, 1.47); the extent of pENE (minor versus major) was not associated with significant prognostic changes. Optimized pN and pathological tumor-node-metastasis stage categories were derived and validated in adjusted hazard ratio approaches. Compared with AJCC8E, AJCC9V staging system showed superior hazard consistency, outcome prediction, and balance, but not hazard discrimination.

"The new staging will better inform clinicians and patients about a patient's prognosis and will minimize inconsistencies in the treatments patients are offered," Ho said in a statement. "Currently, a patient diagnosed as stage 1 might be offered surgery plus radiation and chemotherapy, while another stage 1 patient may be offered surgery alone. The new guidelines will help ensure each patient receives the most appropriate treatment."

Several authors disclosed ties to the biopharmaceutical industry.

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Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.

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