HPV-mediated (p16-positive) oropharyngeal cancer (staging)

Dr Francis Deng et al.

Human papillomavirus (HPV)-mediated oropharyngeal (p16+) cancer staging refers to TNM staging of squamous cell carcinomas of the oropharynx that test positive for p16, an immunohistochemical proxy for HPV infection. Nodal metastases of p16+ squamous cell carcinoma without an identified primary tumor are also staged under this system. This classification is new in the 8th edition of the American Joint Committee on Cancer Staging Manual, published in 2017 1-3.

Clinical criteria apply to all patients before surgical treatment, by using information from physical examination, imaging, and/or needle biopsies.

  • NX: regional lymph nodes cannot be assessed
  • cN0: no regional lymph node metastasis
  • cN1: one or more ipsilateral lymph nodes, all ≤6 cm
  • cN2: contralateral or bilateral lymph nodes, all ≤6 cm
  • cN3: lymph node(s) >6 cm

Pathological criteria apply only to patients treated with surgery who thus have many specimens available for histopathologic examination.

  • NX: regional lymph nodes cannot be assessed
  • pN0: no regional lymph node metastasis
  • pN1: metastasis in ≤4 lymph nodes
  • pN2: metastasis in >4 lymph nodes

The terms pM0 and MX are not valid TNM categories. The following categories may be used:

  • cM0: no evidence of metastases
  • cM1: distant metastasis
  • pM1: distant metastasis, microscopically confirmed
  • stage I
    • [T0, T1, T2], [N0, N1], M0
  • stage II
    • [T0, T1, T2], N2, M0
    • T3, [N0, N1, N2], M0
  • stage III
    • [T0, T1, T2, T3, T4], N3, M0
    • T4, [N0, N1, N2, N3]
  • stage IV
    • [Any T], [Any N], M1
  • stage I
    • [T0, T1, T2], [N0, N1], M0
  • stage II
    • [T0, T1, T2], N2, M0
    • [T3 or T4], [N0, N1], M0
  • stage III
    • [T3, T4], N2, M0
  • ​​stage IV
    • [Any T], [Any N], M1

Both clinical and pathological distant metastasis assessments (cM0, cM1, or pM1) can be used for pTNM stage grouping.

Article information

rID: 67349
System: Head & Neck
Section: Staging
Tag: refs
Synonyms or Alternate Spellings:
  • Oropharyngeal cancer (p16-positive) staging
  • Oropharynx cancer (p16+) staging
  • Oropharyngeal cancer (HPV-positive) staging
  • Human papillomavirus (HPV)-related squamous cell carcinoma of the oropharynx (staging)
  • HPV-associated oropharyngeal carcinoma (staging)

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