Abstract
We evaluated the ability of the American Joint Committee on Cancer 7th edition (AJCC) staging system to prognosticate the overall survival of patients with human papillomavirus (HPV)–positive laryngeal squamous cell carcinoma. Patients diagnosed with laryngeal squamous cell carcinoma treated with curative intent were identified in the National Cancer Database (NCDB) for this retrospective analysis. Multivariate analysis was utilized to determine factors correlated with overall survival in the HPV-negative and HPV-positive cohorts. Unadjusted and propensity-score weighted Kaplan-Meier estimation was used to determine overall survival of HPV-negative and HPV-positive patients across AJCC stage groupings. We identified 3,238 patients with laryngeal squamous cell carcinoma of which 2,812 were HPV-negative and 426 were HPV-positive. Overall survival adjusted for age, sex, and co-morbidity status confirmed significant differences between all consecutive stage groupings in the HPV-negative cohort (I vs. II, P<.001; II vs. III, P<.05; III vs. IVA, P<.001; IVA vs. IVB, P<.05) whereas only stage IVA and IVB (P <.01) exhibited a significant difference in overall survival for HPV-positive patients. The current AJCC staging system does not accurately distinguish risk of mortality for patients with HPV-positive disease. These data support the consideration of HPV status in estimating prognosis as well as clinical trial design and clinical decision making for patients with laryngeal squamous cell carcinoma.
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