人乳头瘤病毒与口咽癌患者的生存。
Human papillomavirus and survival of patients with oropharyngeal cancer.
机构信息
University of Texas M.D. Anderson Cancer Center, Houston, USA.
出版信息
N Engl J Med. 2010 Jul 1;363(1):24-35. doi: 10.1056/NEJMoa0912217. Epub 2010 Jun 7.
BACKGROUND
Oropharyngeal squamous-cell carcinomas caused by human papillomavirus (HPV) are associated with favorable survival, but the independent prognostic significance of tumor HPV status remains unknown.
METHODS
We performed a retrospective analysis of the association between tumor HPV status and survival among patients with stage III or IV oropharyngeal squamous-cell carcinoma who were enrolled in a randomized trial comparing accelerated-fractionation radiotherapy (with acceleration by means of concomitant boost radiotherapy) with standard-fractionation radiotherapy, each combined with cisplatin therapy, in patients with squamous-cell carcinoma of the head and neck. Proportional-hazards models were used to compare the risk of death among patients with HPV-positive cancer and those with HPV-negative cancer.
RESULTS
The median follow-up period was 4.8 years. The 3-year rate of overall survival was similar in the group receiving accelerated-fractionation radiotherapy and the group receiving standard-fractionation radiotherapy (70.3% vs. 64.3%; P=0.18; hazard ratio for death with accelerated-fractionation radiotherapy, 0.90; 95% confidence interval [CI], 0.72 to 1.13), as were the rates of high-grade acute and late toxic events. A total of 63.8% of patients with oropharyngeal cancer (206 of 323) had HPV-positive tumors; these patients had better 3-year rates of overall survival (82.4%, vs. 57.1% among patients with HPV-negative tumors; P<0.001 by the log-rank test) and, after adjustment for age, race, tumor and nodal stage, tobacco exposure, and treatment assignment, had a 58% reduction in the risk of death (hazard ratio, 0.42; 95% CI, 0.27 to 0.66). The risk of death significantly increased with each additional pack-year of tobacco smoking. Using recursive-partitioning analysis, we classified our patients as having a low, intermediate, or high risk of death on the basis of four factors: HPV status, pack-years of tobacco smoking, tumor stage, and nodal stage.
CONCLUSIONS
Tumor HPV status is a strong and independent prognostic factor for survival among patients with oropharyngeal cancer. (ClinicalTrials.gov number, NCT00047008.)
背景
人乳头瘤病毒（HPV）引起的口咽鳞状细胞癌与较好的生存相关，但肿瘤 HPV 状态的独立预后意义仍不清楚。
方法
我们对一项随机试验进行了回顾性分析，该试验比较了加速分割放疗（通过同期加量放疗加速）与标准分割放疗，均联合顺铂治疗，治疗头颈部鳞状细胞癌的 III 或 IV 期或口咽鳞状细胞癌患者，比较肿瘤 HPV 状态与生存的关系。使用比例风险模型比较 HPV 阳性癌症患者与 HPV 阴性癌症患者的死亡风险。
结果
中位随访时间为 4.8 年。接受加速分割放疗组与接受标准分割放疗组的 3 年总生存率相似（70.3% vs. 64.3%；P=0.18；加速分割放疗死亡风险比，0.90；95%置信区间[CI]，0.72 至 1.13），高级急性和晚期毒性事件发生率也相似。共有 323 例口咽癌患者（63.8%）HPV 阳性肿瘤；这些患者 3 年总生存率更好（82.4% vs. HPV 阴性肿瘤患者 57.1%；对数秩检验 P<0.001），经年龄、种族、肿瘤和淋巴结分期、烟草暴露和治疗分组调整后，死亡风险降低 58%（风险比，0.42；95%CI，0.27 至 0.66）。吸烟量每增加 1 包年，死亡风险显著增加。通过递归分区分析，我们根据 HPV 状态、吸烟包年数、肿瘤分期和淋巴结分期这四个因素，将患者分为低、中、高死亡风险。
结论
肿瘤 HPV 状态是口咽癌患者生存的一个强有力的独立预后因素。（临床试验编号，NCT00047008。）
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