International Journal of Clinical Oncology

, Volume 22, Issue 4, pp 682–689 | Cite as

Confirmation of the eighth edition of the AJCC/UICC TNM staging system for HPV-mediated oropharyngeal cancer in Japan

  • Takatsugu Mizumachi
  • Akihiro Homma
  • Tomohiro Sakashita
  • Satoshi Kano
  • Hiromitsu Hatakeyama
  • Satoshi Fukuda
Original Article



Several studies have demonstrated that the seventh edition of the American Joint Committee on Cancer/American Joint Committee on Cancer (AJCC/UICC) TNM staging system does not consistently distinguish between prognostic subgroups for human papillomavirus (HPV)-mediated oropharyngeal squamous cell carcinoma (OPSCC). The eighth edition of the AJCC/UICC TNM staging system came into effect for use with HPV-mediated OPSCC on or after 1 January 2017. This study confirms that the eighth edition of the AJCC/UICC TNM staging system for HPV-mediated OPSCC accurately reflects disease outcomes.

Patients and methods

We retrospectively analyzed 195 patients with OPSCC treated at Hokkaido University Hospital, Sapporo, Japan between 1998 and 2015. HPV status was evaluated by immunohistochemical analysis of p16.


Of the 195 OPSCC patients evaluated, 111 (56.9%) were p16 positive and 84 (43.1%) were p16 negative. The 3-year overall survival rate (OS) was significantly lower in the p16-negative patients with stage III–IV in comparison with those with stage I–II (55.0 vs. 93.1%, respectively; p < 0.01). The 3-year OS did not differ significantly between stage I–II and stage III–IV in the p16-positive patients (86.7 vs 87.7%). According to the eighth edition of the AJCC/UICC TNM staging system, stage I–II and stage III can be differentiated on the basis of the 3-year OS in the p16-positive patients (90.9 vs 70.2%, respectively; p < 0.01).


The seventh edition of the AJCC/UICC TNM staging system is suitable for use with p16-negative patients; however, it does not effectively discriminate between p16-positive patients. Therefore, the eighth edition of the AJCC/UICC TNM staging system is more suitable for HPV-mediated OPSCC in Japan.


AJCC/UICC TNM staging system Head and neck cancer Human papillomavirus Oropharynx p16 



We thank Sachiyo Enju for her technical assistance. This work was supported by a Grant-in-Aid for Young Scientists (B) from Education, Culture, Sports, Science and Technology of Japan.

Compliance with ethical standards

Conflict of interest

No author has any conflict of interest.


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Copyright information

© Japan Society of Clinical Oncology 2017

Authors and Affiliations

  • Takatsugu Mizumachi
    • 1
  • Akihiro Homma
    • 1
  • Tomohiro Sakashita
    • 1
  • Satoshi Kano
    • 1
  • Hiromitsu Hatakeyama
    • 1
  • Satoshi Fukuda
    • 1
  1. 1.Department of Otolaryngology–Head and Neck SurgeryHokkaido University Graduate School of MedicineSapporoJapan

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