Department of Otolaryngology, Samsung Changwon Hospital, Sungkyunkwan University, School of Medicine, Changwon, Republic of Korea.
Oral Oncol. 2012 Dec;48(12):1250-6. doi: 10.1016/j.oraloncology.2012.05.026. Epub 2012 Jun 23.
Human papillomavirus (HPV), a causative agent of oropharyngeal squamous cell carcinoma (SCC), may be detected in metastatic cervical lymph nodes (MCNs). We investigated whether HPV and p16 expression in MCNs can help identify oropharyngeal primaries in patients with cervical lymph node metastases from an unknown primary tumor (CUP) and predict their survival outcomes.
SCC MCNs of 58 patients with CUP were assayed for HPV by in situ hybridization and for p16 and p53 expression by immunohistochemistry. The presence of HPV and p16 in MCN was correlated with oropharyngeal tumor location and prognosis.
Oropharyngeal primaries were found in 20 patients. The sensitivity and negative predictive value (NPV) of HPV for oropharyngeal localization were 90.0% and 92.6%, respectively, and the sensitivity and NPV of p16 were 80.0% and 86.2%, respectively. Multivariate analyses showed that the location of the largest MCN (P=0.035) and HPV (P=0.004) were independent predictors of oropharyngeal tumors. Multivariate analyses showed that p16 expression was an independent predictor of disease-free survival (P=0.030; hazard ratio (HR)=0.286; 95% CI, 0.092-0.887) and that p53 expression (P=0.017; HR=3.154, 95% CI=1.288-8.103) and extracapsular extension of MCN (P=0.010; HR=3.924, 95% CI=1.387-11.097) were independent predictors of overall survival.
Detection of HPV and p16 may help identify hidden oropharyngeal primaries in CUP patients and predict their survival outcomes.
人乳头瘤病毒（HPV）是口咽鳞状细胞癌（SCC）的致病因子，可能在转移性颈淋巴结（MCN）中被检测到。我们研究了 MCN 中的 HPV 和 p16 表达是否有助于识别原发灶不明的颈淋巴结转移（CUP）患者中的口咽原发性肿瘤，并预测其生存结局。
对 58 例 CUP 患者的 SCC MCN 进行原位杂交检测 HPV，免疫组化检测 p16 和 p53 表达。MCN 中 HPV 和 p16 的存在与口咽肿瘤位置和预后相关。
在 20 例患者中发现了口咽原发性肿瘤。HPV 对口咽定位的敏感性和阴性预测值（NPV）分别为 90.0%和 92.6%，p16 的敏感性和 NPV 分别为 80.0%和 86.2%。多变量分析显示，最大 MCN 的位置（P=0.035）和 HPV（P=0.004）是口咽肿瘤的独立预测因子。多变量分析显示，p16 表达是无病生存的独立预测因子（P=0.030；危险比（HR）=0.286；95%CI，0.092-0.887），p53 表达（P=0.017；HR=3.154，95%CI=1.288-8.103）和 MCN 包膜外扩展（P=0.010；HR=3.924，95%CI=1.387-11.097）是总生存的独立预测因子。
检测 HPV 和 p16 可能有助于识别 CUP 患者中隐匿性口咽原发性肿瘤，并预测其生存结局。
