Straetmans Jos M J A A, Olthof Nadine, Mooren Jeroen J, de Jong Jos, Speel Ernst-Jan M, Kremer Bernd
Department of Otorhinolaryngology-Head and Neck Surgery, GROW Institute, Maastricht University Medical Centre, Maastricht, The Netherlands.
Laryngoscope. 2009 Oct;119(10):1951-7. doi: 10.1002/lary.20593.
OBJECTIVES/HYPOTHESIS: Assessment of the prognostic value of nodal status in relation to human papillomavirus (HPV) status and the various treatment modalities in tonsillar squamous cell carcinomas (TSCC).
Retrospective 5-year survival analysis.
A 5-year follow-up of disease-free, disease-specific, and overall survival in a group of 81 patients with TSCC was conducted. The nodal status and integration of HPV-DNA in the genome (detected with fluorescence in situ hybridization) as prognostic indicators were examined while correcting for other clinical parameters (smoking habits, alcohol consumption, treatment modality, differentiation, TNM classification).
Of TSCCs, 41% were positive for HPV type 16. In these TSCCs, the primary tumor was significantly smaller when compared to HVP-negative TSCCs (P = .04), whereas the percentage of cases with cervical metastases was identical. In the total population, it was not nodal involvement, but rather HPV manifestation, which was related to patient prognosis. Within the treatment modalities (surgery combined with radiotherapy and radiotherapy alone), neither nodal status nor HPV were prognostic indicators.
Since a substantial percentage of TSCCs are HPV-positive and metastasizes to cervical lymph nodes in less advanced primary tumors, the N status is an unreliable prognostic indicator in TSCCs. HPV is only prognostically relevant in the total tumor population, but loses its value within patient groups receiving a single treatment modality. The value of HPV for prognosis of patients with TSCC requires further study.
目的/假设：评估扁桃体鳞状细胞癌（TSCC）中淋巴结状态与人乳头瘤病毒（HPV）状态及各种治疗方式的预后价值。
回顾性5年生存分析。
对81例TSCC患者进行了5年的无病生存期、疾病特异性生存期和总生存期随访。在校正其他临床参数（吸烟习惯、饮酒情况、治疗方式、分化程度、TNM分类）的同时，将淋巴结状态和HPV-DNA在基因组中的整合情况（通过荧光原位杂交检测）作为预后指标进行研究。
在TSCC中，41%的病例HPV-16呈阳性。在这些TSCC中，与HPV阴性的TSCC相比，原发肿瘤明显更小（P = 0.04），而发生颈部转移的病例百分比相同。在总体人群中，与患者预后相关的是HPV表现，而非淋巴结受累情况。在治疗方式（手术联合放疗和单纯放疗）中，淋巴结状态和HPV均不是预后指标。
由于相当比例的TSCC为HPV阳性，且在较早期的原发肿瘤中就会转移至颈部淋巴结，因此N状态在TSCC中是不可靠的预后指标。HPV仅在整个肿瘤人群中与预后相关，但在接受单一治疗方式的患者组中失去其价值。HPV对TSCC患者预后的价值需要进一步研究。
