Validation of the ICON-S staging for HPV-associated oropharyngeal carcinoma using a pre-defined treatment policy

Publication date: March 2017
Source:Oral Oncology, Volume 66
Author(s): Sandro V Porceddu, Rob Milne, Elizabeth Brown, Anne Bernard, Reza Rahbari, Bena Cartmill, Matthew Foote, Margaret McGrath, Jermaine Coward, Benedict Panizza
ObjectivesTo determine whether the International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S) for HPV associated oropharyngeal carcinoma (HPV+OPC) is a better discriminator of overall survival (OS), compared with the 7th edition (7th Ed) AJCC/UICC TNM staging following curative radiotherapy (RT).Material and methodsThe 5-year OS for all patients with non-metastatic (M0) p16-confirmed OPC treated between 2005 and 2015 was determined and grouped based on the 7th Ed AJCC/UICC TNM and ICON-S staging.ResultsA total of 279 patients met the inclusion criteria. The 5-year OS with the 7th Ed TNM classification were Stage I/II 88.9% (95% CI; 70.6–100%), Stage III 93.8% (95% CI; 85.9–100%), Stage IVa 86.4% (95% CI; 81.6–91.5%) and Stage IVb 62.3% (95% CI; 46.8–82.8%). On multivariate Cox regression analysis there was no statistically significant OS difference when comparing Stage I/II with, Stage III (p=0.98, HR=0.97, 95% CI; 0.11–8.64), IVa (p=0.67, HR=1.56, 95% CI; 0.2–11.94) and IVb (p=0.11, HR=5.54, 95% CI; 0.69–44.52), respectively.The 5-year OS with ICON-S staging were Stage I 93.6% (95% CI; 89.4–98.0%), Stage II 81.9% (95% CI; 73.7–91.1%) and Stage III 69.1% (95%; 57.9–82.6%). There was a consistent decrease of OS with increasing stage. On multivariate Cox regression analysis, when compared to Stage I, OS was significantly lower for stage II (p=0.007, HR=2.84, 95% CI; 1.33–6.05) and stage III (p<0.001, HR=3.78, 95% CI; 1.81–7.92), respectively.ConclusionThe ICON-S staging provides better OS stratification for HPV+OPC following RT compared with the 7th Ed TNM staging.



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