Isayeva Tatyana, Li Yufeng, Maswahu Daniel, Brandwein-Gensler Margaret
Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35233-1932, USA.
Head Neck Pathol. 2012 Jul;6 Suppl 1(Suppl 1):S104-20. doi: 10.1007/s12105-012-0368-1. Epub 2012 Jul 3.
Perhaps one of the most important developments in head and neck oncology of the past decade is the demonstration that patients with human papillomavirus (HPV)-mediated oropharyngeal cancers have significantly improved outcomes, compared to HPV-negative counterpart patients. This has become the basis for clinical trials investigating the impact on "treatment deintensification" for patients with HPV-mediated oropharyngeal cancers. Unfortunately, the significance of HPV in non-oropharyngeal head and neck cancers is much less certain. Our goal is to systematically review the published data regarding the role HPV in carcinomas of the oral cavity, larynx, sinonasal tract and nasopharynx with respect to HPV detection frequency, viral activity, and association with outcome. We also present preliminary data on HPV16/18 transcriptional status in oral cavity carcinomas, as well as salivary gland neoplasia, as determined by nested reverse transcription PCR for HPV E6/E7 RNA. The weighted prevalence (WP) of HPV DNA detection in 4,195 oral cavity cancer patients is 20.2 %, (95 % CI 16.0 %, 25.2 %). HPV16 is the most common type detected. Importantly, no data currently demonstrates a significant association between the presence of HPV DNA and improved outcome. The WP of HPV DNA in 1,712 laryngeal cancer patients is 23.6 %, (95 % CI 18.7 %, 29.3 %). Similarly, no association has yet been demonstrated between HPV DNA status and outcome. The WP of HPV DNA detection in 120 sinonasal cancer patients is 29.6 % (95 % CI 17.8 %, 44.9 %), and in 154 nasopharyngeal carcinoma patients is 31.1 %, (95 % CI 20.3 %, 44.5 %). Recent preliminary data also suggests an association between HPV and certain salivary gland neoplasms. The clinical significance of these findings is unclear. The published data strongly support the need for studies on patients with oral and laryngeal carcinomas that will be powered to find any differences in clinical outcome with respect to HR-HPV and p16 overexpression.
在过去十年中，头颈肿瘤学领域最重要的进展之一或许是证实了与人类乳头瘤病毒（HPV）阴性的口咽癌患者相比，HPV介导的口咽癌患者的预后有显著改善。这已成为研究HPV介导的口咽癌患者“治疗减强度”影响的临床试验基础。不幸的是，HPV在非口咽头颈癌中的意义尚不确定。我们的目标是系统回顾已发表的数据，这些数据涉及HPV在口腔癌、喉癌、鼻窦癌和鼻咽癌中的作用，包括HPV检测频率、病毒活性以及与预后的关联。我们还展示了通过巢式逆转录PCR检测HPV E6/E7 RNA所确定的口腔癌以及涎腺肿瘤中HPV16/18转录状态的初步数据。4195例口腔癌患者中HPV DNA检测的加权患病率（WP）为20.2%，（95%置信区间16.0%，25.2%）。HPV16是检测到的最常见类型。重要的是，目前尚无数据表明HPV DNA的存在与预后改善之间存在显著关联。1712例喉癌患者中HPV DNA的WP为23.6%，（95%置信区间18.7%，29.3%）。同样，HPV DNA状态与预后之间尚未显示出关联。120例鼻窦癌患者中HPV DNA检测的WP为29.6%（95%置信区间17.8%，44.9%），154例鼻咽癌患者中为31.1%，（95%置信区间20.3%，44.5%）。近期的初步数据还表明HPV与某些涎腺肿瘤之间存在关联。这些发现的临床意义尚不清楚。已发表的数据有力地支持了针对口腔癌和喉癌患者开展研究的必要性，这些研究应有足够的样本量来发现高危型HPV（HR-HPV）和p16过表达在临床结局方面的任何差异。
