Value of transoral surgery for human papillomavirus-mediated oropharyngeal cancer: validation of a new staging system in Japanese patients

OBJECTIVE: This study aimed to validate new staging of Japanese patients with human papillomavirus-mediated oropharyngeal cancer (HPV(+)-OPC) and the effectiveness of transoral surgery. METHODS: Fifty-three patients with HPV(+)-OPC were classified according to the seventh and eighth editions of the American Joint Committee on Cancer (AJCC) staging, along with assessment of prognosis, smoking and alcohol status, and treatment outcome. Transoral videolaryngoscopic surgery (TOVS) was performed as transoral surgery. RESULTS: The 5-year overall survival (OS) rate was 77.3% in all patients. Five-year OS rates of seventh edition staging were as follows: II, 100%; III, 100%; IVa, 75.9%; and IVb and IVc, 0%. Five-year OS rates of the eighth edition clinical staging were as follows: I, 89.3%; II, 88.9%; III, 46.3%; and IV, 0%. In non-smoking and smoking patients with HPV(+)-OPC, the 5-year OS rates were 90.9% and 70.7%, respectively. TOVS was used for treating 20 smokers with HPV(+)-OPC (5-year OS: 85.7%), while 12 were treated with chemoradiotherapy (5-year OS: 75.0%). CONCLUSIONS: The eighth edition of the AJCC determines the prognosis of HPV(+)-OPC more accurately than the seventh edition in clinical staging. Smokers with HPV(+)-OPC have a poor prognosis, but TOVS might improve the prognosis.