| Objective:The American Joint Committee on cancer released the 8th edition of TNM staging manual in 2017.The new edition of TNM staging manual has been significantly updated compared with the old edition.Two new indicators of human papillomavirus and extranodal extension have been added to the part of oropharyngeal cancer.The research focus of this study is human papillomavirus.With the introduction of this index,oropharyngeal cancer is divided into HPV-mediated oropharyngeal cancer and non-mediated oropharyngeal cancer.The purpose of this study was to analyze and compare the differences in survival and prognosis of patients with two types of oropharyngeal cancer,and to compare the new and the old stages and prognosis,so as to provide clinical basis for the treatment strategy and prognosis evaluation of oropharyngeal cancer.Methods:Patients with primary oropharyngeal squamous cell carcinoma treated by oral and maxillofacial surgery in the Affiliated Hospital of Qingdao University from January 2010 to December 2016 were collected.The pathological specimens were re-evaluated by p16 immunohistochemistry,and survival information of enrolled patients was collected.The8 th Edition TNM staging system was used to stage the tumor,analyze and compare the survival rate of patients with HPV-mediated oropharyngeal cancer and non-mediated oropharyngeal cancer.The SPSS 25.0 software package was used for statistical analysis,and the Kaplan-Meier method was used to draw the survival curve.P<0.05 indicated that the difference was statistically significant.Then the 7th Edition TNM staging system was used to stage the tumor,analyze and compare the survival of patients in the same period between the two editions,make statistical analysis with SPSS 25.0 software package,and draw the survival curve with the Kaplan-Meier method.P<0.05 indicated that the difference was statistically significant.Results:A total of 336 patients with oropharyngeal squamous cell carcinoma met the inclusion criteria,including 278 males(82.74%)and 58 females(17.26%).Patients ranged in age from 27 to 85 years,with a median age of 58 years and an average age of58.2 years.Median follow-up time was 40 months(range,3 to 144 months),225 cases(66.96%)with a history of drinking and 230 cases(68.45%)with a history of smoking.The subsites of oropharyngeal cancer onset included the posterior pharyngeal wall(41.96%),the soft palate(26.79%)and the root of the tongue(22.92%).Sixty-six cases(19.64%)only underwent extended resection of primary tumors,270 cases(80.36%)underwent extended resection of primary tumors and neck lymph node dissection,90cases(26.79%)only underwent surgical treatment,and 246 cases(73.21%)underwent surgical treatment with adjuvant treatment.A total of 101 cases(30.1%)of HPV-mediated oropharyngeal carcinoma were detected by immunohistochemical p16 method.The five-year survival rate of patients with HPV-mediated oropharyngeal cancer was 47.5%,and the median survival time was58 months(range,8 to 140 months);The five-year survival rate of patients with non-mediated related oropharyngeal cancer was 34.0%,and the median survival time was37 months(range,3 to 120 months).The survival curve of patients with HPV-mediated oropharyngeal cancer was significantly separated from that of patients with non-mediated oropharyngeal cancer(P<0.05).In the comparison of the two versions,the 7th and 8th versions of the early survival curve were not separated,and the difference was not statistically significant(P>0.05).The survival curve of patients with advanced stage was significantly separated after 12 months between the 7th edition and the 8th Edition(P<0.05).Conclusions:The survival time of patients with HPV-mediated oropharyngeal cancer was longer than that of non-mediated oropharyngeal cancer.The differences of survival time of patients with early stage cancer showed no statistically significant.However,among patients with advanced-stage cancer,the differences were statistically significant.The more advanced stage,the greater the difference.The stage degradation of HPV-mediated oropharyngeal cancer patients is reasonable,and the survival time of a considerable part of HPV-mediated oropharyngeal cancer patients in AJCC 7 is underestimated.Staging directly affects treatment decisions.A considerable number of HPV-mediated oropharyngeal cancer patients in AJCC 7 had been over treated.The prognosis stage of AJCC 8 is more consistent with the actual survival of patients,and the survival expectation is more accurate.AJCC 8 staging is more reasonable for HPV-mediated oropharyngeal cancer and better guide clinical work. |
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