{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T09:12:54Z","timestamp":1775898774339,"version":"3.50.1"},"reference-count":20,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2016,4,25]],"date-time":"2016-04-25T00:00:00Z","timestamp":1461542400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Patients with human papillomavirus (HPV)\u2013related oropharyngeal cancers (OPCs) have superior outcomes in comparison with patients with non\u2013HPV\u2010induced OPCs. This study confirms that a previously proposed HPV risk\u2013adapted restaging system better reflects disease outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The National Cancer Data Base was used to analyze 8803 HPV+ OPC patients. Univariate and multivariate analyses were performed to identify the utility of both American Joint Commission on Cancer (AJCC) staging and HPV risk\u2013adapted staging in predicting the outcomes of patients with HPV+ OPC and other factors influencing survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>With a median follow\u2010up of 27.1 months, 3.2% had AJCC stage I disease and 6.6%, 19.4%, and 70.9% had stage II, III, and IV disease, respectively. When the patients were restaged according to HPV risk\u2013adapted staging, 76.6% had stage I disease, 9.9% had stage II disease, and 13.5% had stage III disease. The 4\u2010year overall survival rates according to HPV risk\u2013adapted staging were 85.8%, 77.3%, and 64.6% for stages I, II, and III, respectively, but the rates for AJCC stages I, II, III, and IV were 90.1%, 86.1%, 87.0%, and 80.1%, respectively. Patients with HPV+ metastatic disease at diagnosis had a significantly improved median survival of 20.5 months versus 11.1 months with HPV\u2013 disease (<jats:italic>P<\/jats:italic> &lt; .01). In the multivariate analysis, survival was also affected by the age at treatment, a nontonsillar or base\u2010of\u2010tongue primary site, private insurance, an annual income \u2265 $48,000\/y, and the comorbidity index (all <jats:italic>P<\/jats:italic> values &lt; .01).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Outcomes of HPV+ OPC are significantly improved in comparison with HPV\u2013 OPC outcomes, and the current AJCC staging system does not accurately reflect disease outcomes. This study has retrospectively confirmed that an HPV risk\u2013adapted restaging structure more accurately stratifies patients. Under this new risk\u2010stratified staging system, patients may be more accurately stratified for investigation into treatment escalation or de\u2010escalation studies. <jats:bold><jats:italic>Cancer<\/jats:italic> 2016;122:2021\u201330<\/jats:bold>. \u00a9 <jats:italic>2016 American Cancer Society<\/jats:italic>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.30021","type":"journal-article","created":{"date-parts":[[2016,4,25]],"date-time":"2016-04-25T20:22:50Z","timestamp":1461615770000},"page":"2021-2030","source":"Crossref","is-referenced-by-count":31,"title":["Confirmation of proposed human papillomavirus risk\u2013adapted staging according to AJCC\/UICC TNM criteria for positive oropharyngeal carcinomas"],"prefix":"10.1002","volume":"122","author":[{"given":"Zachary D.","family":"Horne","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology University of Pittsburgh Cancer Institute Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott M.","family":"Glaser","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pittsburgh Cancer Institute Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John A.","family":"Vargo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pittsburgh Cancer Institute Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert L.","family":"Ferris","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Pittsburgh Cancer Institute Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Goundappa K.","family":"Balasubramani","sequence":"additional","affiliation":[{"name":"Epidemiology Data Center, Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"Clump","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pittsburgh Cancer Institute Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dwight E.","family":"Heron","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pittsburgh Cancer Institute Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sushil","family":"Beriwal","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pittsburgh Cancer Institute Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,4,25]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"TNM Classification of Malignant Tumours","author":"Sobin 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