酒精和烟草与HPV16相关的头颈癌之间不存在关联。

Lack of association of alcohol and tobacco with HPV16-associated head and neck cancer.

作者信息

Applebaum Katie M, Furniss C Sloane, Zeka Ariana, Posner Marshall R, Smith Judith F, Bryan Janine, Eisen Ellen A, Peters Edward S, McClean Michael D, Kelsey Karl T

机构信息

Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA.

出版信息

J Natl Cancer Inst. 2007 Dec 5;99(23):1801-10. doi: 10.1093/jnci/djm233. Epub 2007 Nov 27.

DOI:10.1093/jnci/djm233

PMID:18042931

Abstract

BACKGROUND

Human papillomavirus type 16 (HPV16) seropositivity and alcohol and tobacco use have been associated with risk of head and neck squamous cell carcinoma (HNSCC). However, it is less clear whether HPV16 influences HNSCC risk associated with alcohol and tobacco use.

METHODS

Incident cases of HNSCC diagnosed between December 1999 and December 2003 were identified from nine medical facilities in Greater Boston, MA. Control subjects were frequency matched to case subjects on age, sex, and town of residence. A total of 485 case subjects and 549 control subjects reported information on lifetime smoking and alcohol consumption and provided sera, which was used to determine presence of HPV16 antibodies. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of HNSCC risk by alcohol consumption (drinks per week: < 3, 3 to < 8, 8 to < 25, > or = 25) and smoking (pack-years: none, > 0 to < 20, 20 to < 45, > or = 45), adjusting for age, sex, race, education, and HPV16 serology. Polytomous logistic regression was used to estimate odds ratios and 95% confidence intervals for the association of HPV16 serology, alcohol consumption, and tobacco use in site-specific analyses. All statistical tests were two-sided.

RESULTS

The strongest risk factors by tumor site were smoking for laryngeal cancer, alcohol for cancer of the oral cavity, and HPV16 for pharyngeal cancer. For pharyngeal cancer, risk increased with increasing alcohol consumption (OR(> or = 25 versus < 3 drinks per week) = 5.1, 95% CI = 2.4 to 11.0) and smoking (OR(> or = 45 pack-years versus never smoker) = 6.9, 95% CI = 3.1 to 15.1) among HPV16-seronegative subjects but not among HPV16-seropositive subjects (P(interaction, HPV16 serology and alcohol) = .002; P(interaction, HPV16 serology and smoking) = .007). Among light drinkers or never smokers, HPV16 seropositivity was associated with a 30-fold increased risk of pharyngeal cancer.

CONCLUSIONS

Alcohol or tobacco use does not further increase risk of HPV16-associated pharyngeal cancer. HNSCC risk associated with smoking, alcohol, and HPV16 differs by tumor site.

摘要

背景

16型人乳头瘤病毒（HPV16）血清阳性以及饮酒和吸烟与头颈部鳞状细胞癌（HNSCC）风险相关。然而，HPV16是否影响与饮酒和吸烟相关的HNSCC风险尚不清楚。

方法

从马萨诸塞州大波士顿地区的9家医疗机构中确定1999年12月至2003年12月期间诊断出的HNSCC新发病例。对照对象在年龄、性别和居住城镇方面与病例对象进行频率匹配。共有485例病例对象和549例对照对象报告了终生吸烟和饮酒情况并提供了血清，用于检测HPV16抗体的存在。采用无条件逻辑回归来估计按饮酒量（每周饮酒量：<3杯、3至<8杯、8至<25杯、≥25杯）和吸烟量（吸烟包年数：无、>0至<20、20至<45、≥45）划分的HNSCC风险的比值比（OR）和95%置信区间（CI），并对年龄、性别、种族、教育程度和HPV16血清学进行校正。采用多分类逻辑回归来估计HPV16血清学、饮酒和吸烟在特定部位分析中的关联的比值比和95%置信区间。所有统计检验均为双侧检验。

结果

按肿瘤部位划分，最强的风险因素为：喉癌是吸烟，口腔癌是饮酒，咽癌是HPV16。对于咽癌，在HPV16血清阴性的受试者中，风险随饮酒量增加（每周≥25杯与<3杯相比，OR = 5.1，95%CI = 2.4至11.0）和吸烟量增加（≥45吸烟包年数与从不吸烟者相比，OR = 6.9，95%CI = 3.1至15.1）而增加，但在HPV16血清阳性的受试者中并非如此（HPV16血清学与饮酒的交互作用P = 0.002；HPV16血清学与吸烟的交互作用P = 0.007）。在轻度饮酒者或从不吸烟者中，HPV16血清阳性与咽癌风险增加30倍相关。