American Joint Committee on Cancer 8^th edition staging—an improvement in prognostication in HPV-associated oropharyngeal cancer?

Updates to the TNM staging system are needed in instances when clinical outcomes improve or patient demographics change. Since 1990, the incidence of HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) has increased at a rate of 5% per year (1,2). These patients are distinct from HPV negative OPSCC counterparts as the demographic is younger, healthier, with less exposure to tobacco (1). Furthermore, patients with HPV-associated OPSCC have a disease that is highly responsive to treatment and portends a favorable prognosis (3). Given the dramatically improved survival of patients with HPV-associated OPSCC, it became clear that the seventh edition of the American Joint Committee on Cancer (AJCC 7^th ed) staging system was no longer accurate in predicting outcomes in this patient population (4).