American Joint Committee on Cancer 8th edition staging—an improvement in prognostication in HPV-associated oropharyngeal cancer?
Updates to the TNM staging system are needed in instances when clinical outcomes improve or patient demographics change. Since 1990, the incidence of HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) has increased at a rate of 5% per year (1,2). These patients are distinct from HPV negative OPSCC counterparts as the demographic is younger, healthier, with less exposure to tobacco (1). Furthermore, patients with HPV-associated OPSCC have a disease that is highly responsive to treatment and portends a favorable prognosis (3). Given the dramatically improved survival of patients with HPV-associated OPSCC, it became clear that the seventh edition of the American Joint Committee on Cancer (AJCC 7th ed) staging system was no longer accurate in predicting outcomes in this patient population (4).