Age-Related Risk Stratification in HPV-Positive Oropharyngeal Cancer: Implications for Treatment De-Intensification

Area of Science:

• Oncology
• Cancer Research
• Clinical Trials

Background:

• The AJCC eighth edition staging system for HPV-positive oropharyngeal cancer (OPC) needs improvement for personalized treatment.
• Current staging is insufficient for risk stratification in HPV-positive OPC.

Purpose of the Study:

• To identify an optimal age threshold for risk stratification in HPV-positive OPC.
• To evaluate the association of age with overall survival (OS) for improved treatment strategies.

Main Methods:

• Utilized SEER, UHN, and NCC databases (2018-2021) for HPV-positive OPC cases.
• Employed restricted cubic spline and recursive partitioning analysis (RPA) to determine age thresholds and stratify risk.
• Assessed prognostic factors using multivariable Cox proportional hazards models.

Main Results:

• Identified 62 years as a critical age threshold; patients younger than 62 had significantly improved OS.
• Developed a five-group risk stratification model (extremely low to extremely high risk) with distinct 2-year OS rates.
• Extremely low-risk patients (younger than 62, T0-2N0-1M0) showed no OS difference between radiotherapy alone and chemoradiotherapy.

Conclusions:

• A novel risk stratification model for p16-positive OPC integrates AJCC staging and age.
• Extremely low-risk patients may not benefit from concurrent chemotherapy, suggesting de-escalation is a viable option.
• Findings support the design of future de-escalation clinical trials for selected OPC patients.