Impact of HPV Status on the Prognostic Potential of the AJCC Staging System for Larynx Cancer

Stacey M. Davidson, Huasing C. Ko, Paul M. Harari, Aaron M. Wieland, Shuai Chen, Andrew M. Baschnagel, Randall J. Kimple, and Matthew E. Witek

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Objective: We evaluated the ability of the American Joint Committee on Cancer (AJCC) seventh edition staging system to prognosticate the overall survival of patients with human papillomavirus (HPV)–positive laryngeal squamous cell carcinoma. Study Design: Retrospective analysis. Setting: National Cancer Database. Subjects and Methods: Patients diagnosed with laryngeal squamous cell carcinoma who were treated with curative intent were identified in the National Cancer Database. 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. Results: We identified 3238 patients with laryngeal squamous cell carcinoma, of which 2812 were HPV negative and 426 were HPV positive. Overall survival adjusted for age, sex, and comorbidity status confirmed significant differences among all consecutive stage groupings (I vs II, P <.001; II vs III, P <.05; III vs IVA, P <.001; IVA vs IVB, P <.05) in the HPV-negative cohort, whereas only stages IVAs and IVB (P <.01) exhibited a significant difference in overall survival for HPV-positive patients. Conclusion: 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.

Original languageEnglish (US)
JournalOtolaryngology - Head and Neck Surgery (United States)
StateAccepted/In press - Apr 1 2018
Externally publishedYes


  • cancer
  • human papillomavirus
  • larynx
  • prognosis
  • squamous cell carcinoma

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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