In transoral robotic surgery (TORS) for oropharyngeal SCC (p16-positive), what is the clinical significance of p16 immunohistochemistry as a surrogate marker for HPV status?
- A p16-positive tumours are more aggressive and require intensified chemoradiation
- B p16-positive status correlates with improved prognosis and forms the basis of AJCC 8th edition separate staging for HPV-related oropharyngeal SCC ✓
- C p16 positivity indicates TP53 mutation and guides targeted therapy
- D p16 overexpression predicts resistance to platinum-based chemotherapy
Correct answer: B. p16-positive status correlates with improved prognosis and forms the basis of AJCC 8th edition separate staging for HPV-related oropharyngeal SCC
Explanation
AJCC 8th edition introduced a separate staging system specifically for HPV-related (p16-positive) oropharyngeal SCC because these tumours have markedly better outcomes than HPV-negative disease. p16 (CDKN2A) overexpression reflects disruption of the Rb pathway by HPV E7 oncoprotein and is a validated surrogate for high-risk HPV status. This staging de-escalates many patients from Stage IV to Stage I/II, reflecting the biological reality of improved prognosis and supporting de-escalation treatment trials.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.