Department of Otolaryngology, Medical College of Georgia, Augusta, Georgia, USA.
Laryngoscope. 2010 Aug;120(8):1531-7. doi: 10.1002/lary.20984.
OBJECTIVES/HYPOTHESIS: Mortality for black males with head and neck squamous cell carcinoma (HNSCC) is twice that of white males or females. Human papillomavirus (HPV)-active HNSCC, defined by the concurrent presence of high-risk type HPV DNA and host cell p16(INK4a) expression, is associated with decreased mortality. We hypothesized that prevalence of this HPV-active disease class would be lower in black HNSCC patients compared to white patients.
Multi-institutional retrospective cohort analysis.
Real-time polymerase chain reaction was used to evaluate for high-risk HPV DNA presence. Immunohistochemistry for p16(INK4a) protein was used as a surrogate marker for HPV oncoprotein activity. Patients were classified as HPV-negative (HPV DNA-negative, p16(INK4a) low), HPV-inactive (HPV DNA-positive, p16(INK4a) low), and HPV-active (HPV DNA-positive, p16(INK4a) high). Overall survival and recurrence rates were compared by Fisher exact test and Kaplan-Meier analysis.
There were 140 patients with HNSCC who met inclusion criteria. Self-reported ethnicity was white (115), black (25), and other (0). Amplifiable DNA was recovered from 102/140 patients. The presence of HPV DNA and the level of p16(INK4a) expression were determined, and the results were used to classify these patients as HPV-negative (44), HPV-inactive (33), and HPV-active (25). Patients with HPV-active HNSCC had improved overall 5-year survival (59.7%) compared to HPV-negative and HPV-inactive patients (16.9%) (P = .003). Black patients were less likely to have HPV-active disease (0%) compared to white patients (21%) (P = .017).
The favorable HPV-active disease class is less common in black than in white patients with HNSCC, which appears to partially explain observed ethnic health disparities.
目的/假设：黑人男性头颈部鳞状细胞癌（HNSCC）的死亡率是白人男性或女性的两倍。人乳头瘤病毒（HPV）阳性 HNSCC 是指同时存在高危型 HPV DNA 和宿主细胞 p16（INK4a）表达，与死亡率降低有关。我们假设与白人患者相比，黑人 HNSCC 患者中这种 HPV 阳性疾病的发生率较低。
多机构回顾性队列分析。
实时聚合酶链反应用于评估高危型 HPV DNA 的存在。p16（INK4a）蛋白的免疫组织化学用于作为 HPV 癌蛋白活性的替代标志物。患者被分为 HPV 阴性（HPV DNA 阴性，p16（INK4a）低）、HPV 不活跃（HPV DNA 阳性，p16（INK4a）低）和 HPV 活跃（HPV DNA 阳性，p16（INK4a）高）。通过 Fisher 精确检验和 Kaplan-Meier 分析比较总生存率和复发率。
符合纳入标准的 HNSCC 患者有 140 例。自我报告的种族为白人（115 例）、黑人（25 例）和其他（0 例）。从 140 例患者中回收了可扩增 DNA。确定了 HPV DNA 的存在和 p16（INK4a）表达水平，并根据这些结果将这些患者分为 HPV 阴性（44 例）、HPV 不活跃（33 例）和 HPV 活跃（25 例）。HPV 阳性 HNSCC 患者的 5 年总生存率（59.7%）明显高于 HPV 阴性和 HPV 不活跃患者（16.9%）（P=.003）。与白人患者（21%）相比，黑人患者发生 HPV 阳性疾病的可能性较低（0%）（P=.017）。
与白人 HNSCC 患者相比，黑人 HNSCC 患者中 HPV 阳性疾病较少见，这似乎部分解释了观察到的种族健康差异。
