人乳头瘤病毒与美国口咽癌发病率的上升
Human papillomavirus and rising oropharyngeal cancer incidence in the United States.
机构信息
National Cancer Institute, National Institutes of Health, 6120 Executive Blvd, EPS 7072, Rockville, MD 20852, USA.
出版信息
J Clin Oncol. 2011 Nov 10;29(32):4294-301. doi: 10.1200/JCO.2011.36.4596. Epub 2011 Oct 3.
PURPOSE
Recent increases in incidence and survival of oropharyngeal cancers in the United States have been attributed to human papillomavirus (HPV) infection, but empirical evidence is lacking.
PATIENTS AND METHODS
HPV status was determined for all 271 oropharyngeal cancers (1984-2004) collected by the three population-based cancer registries in the Surveillance, Epidemiology, and End Results (SEER) Residual Tissue Repositories Program by using polymerase chain reaction and genotyping (Inno-LiPA), HPV16 viral load, and HPV16 mRNA expression. Trends in HPV prevalence across four calendar periods were estimated by using logistic regression. Observed HPV prevalence was reweighted to all oropharyngeal cancers within the cancer registries to account for nonrandom selection and to calculate incidence trends. Survival of HPV-positive and HPV-negative patients was compared by using Kaplan-Meier and multivariable Cox regression analyses.
RESULTS
HPV prevalence in oropharyngeal cancers significantly increased over calendar time regardless of HPV detection assay (P trend < .05). For example, HPV prevalence by Inno-LiPA increased from 16.3% during 1984 to 1989 to 71.7% during 2000 to 2004. Median survival was significantly longer for HPV-positive than for HPV-negative patients (131 v 20 months; log-rank P < .001; adjusted hazard ratio, 0.31; 95% CI, 0.21 to 0.46). Survival significantly increased across calendar periods for HPV-positive (P = .003) but not for HPV-negative patients (P = .18). Population-level incidence of HPV-positive oropharyngeal cancers increased by 225% (95% CI, 208% to 242%) from 1988 to 2004 (from 0.8 per 100,000 to 2.6 per 100,000), and incidence for HPV-negative cancers declined by 50% (95% CI, 47% to 53%; from 2.0 per 100,000 to 1.0 per 100,000). If recent incidence trends continue, the annual number of HPV-positive oropharyngeal cancers is expected to surpass the annual number of cervical cancers by the year 2020.
CONCLUSION
Increases in the population-level incidence and survival of oropharyngeal cancers in the United States since 1984 are caused by HPV infection.
目的
美国口咽癌的发病率和存活率最近有所上升，这归因于人乳头瘤病毒（HPV）感染，但缺乏实证证据。
方法
通过聚合酶链反应和基因分型（Inno-LiPA）、HPV16 病毒载量和 HPV16 mRNA 表达，对来自监测、流行病学和最终结果（SEER）残留组织储存库计划中的三个基于人群的癌症登记处收集的 271 例口咽癌（1984-2004 年）进行 HPV 状态检测。使用逻辑回归估计四个日历期间 HPV 流行率的趋势。对癌症登记处内所有口咽癌进行观察 HPV 流行率的重新加权，以说明非随机选择，并计算发病率趋势。通过 Kaplan-Meier 和多变量 Cox 回归分析比较 HPV 阳性和 HPV 阴性患者的生存情况。
结果
无论 HPV 检测方法如何（P 趋势<.05），口咽癌中的 HPV 流行率随着时间的推移显著增加。例如，Inno-LiPA 检测的 HPV 流行率从 1984 年至 1989 年的 16.3%上升至 2000 年至 2004 年的 71.7%。HPV 阳性患者的中位生存期明显长于 HPV 阴性患者（131 个月与 20 个月；对数秩 P<.001；调整后的危险比，0.31；95%CI，0.21 至 0.46）。HPV 阳性患者的生存率随时间推移显著增加（P=.003），而 HPV 阴性患者的生存率则无显著变化（P=.18）。1988 年至 2004 年，HPV 阳性口咽癌的人群发病率增加了 225%（95%CI，208%至 242%）（从每 10 万人 0.8 例增至每 10 万人 2.6 例），HPV 阴性癌症的发病率下降了 50%（95%CI，47%至 53%；从每 10 万人 2.0 例降至每 10 万人 1.0 例）。如果最近的发病率趋势持续下去，到 2020 年，HPV 阳性口咽癌的年发病数预计将超过宫颈癌的年发病数。
结论
自 1984 年以来，美国口咽癌的发病率和存活率呈上升趋势，这归因于 HPV 感染。
Zotero 插件