Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queens University Belfast, Belfast, UK.
Oral Oncol. 2012 Dec;48(12):1191-201. doi: 10.1016/j.oraloncology.2012.06.019. Epub 2012 Jul 28.
Human Papillomavirus (HPV) related oropharyngeal squamous cell carcinomas (OPSCCs) are reported to have improved prognosis and survival in comparison to other head and neck squamous cell cancers (HNSCCs). This systematic review and meta-analysis examines survival differences in HPV-positive HNSCC and OPSCC subtypes including tonsillar carcinoma in studies not previously investigated. Four electronic databases were searched from their inception till April 2011. A random effects meta-analysis was used to pool study estimates evaluating disease-specific (death from HNSCC), overall (all-cause mortality), progression-free and disease-free (recurrence free) survival outcomes in HPV-positive vs. HPV-negative HNSCCs. All statistical tests were two-sided. Forty-two studies were included. Patients with HPV-positive HNSCC had a 54% better overall survival compared to HPV-negative patients HR 0.46 (95% CI 0.37-0.57); the pooled HR for tonsillar cancer and OPSCC was 0.50 (95% CI 0.33-0.77) and HR 0.47 (95% CI 0.35-0.62) respectively. The pooled HR for disease specific survival was 0.28 (95% CI 0.19-0.40); similar effect sizes were found irrespective of the adjustment for confounders, HPV detection methods or study location. Both progression-free survival and disease-free survival were significantly improved in HPV-positive HNSCCs. HPV-positive HNSCCs and OPSCCs patients have a significantly lower disease specific mortality and are less likely to experience progression or recurrence of their cancer than HPV-negative patients; findings which have connotations for treatment selection in these patients.
人乳头瘤病毒（HPV）相关的口咽鳞状细胞癌（OPSCC）与其他头颈部鳞状细胞癌（HNSCC）相比，其预后和生存率均有所改善。本系统回顾和荟萃分析检查了在 HPV 阳性 HNSCC 和 OPSCC 亚型（包括未先前研究的扁桃体癌）中，在研究中观察到的生存率差异。从建立到 2011 年 4 月，四个电子数据库被搜索。使用随机效应荟萃分析汇总了研究评估结果，这些研究评估了 HPV 阳性与 HPV 阴性 HNSCC 中疾病特异性（HNSCC 死亡）、总生存（全因死亡率）、无进展和无病生存（无复发）的生存结果。所有统计检验均为双侧。共纳入 42 项研究。HPV 阳性 HNSCC 患者的总体生存率比 HPV 阴性患者高 54%，HR 为 0.46（95%CI 0.37-0.57）；扁桃体癌和 OPSCC 的汇总 HR 分别为 0.50（95%CI 0.33-0.77）和 0.47（95%CI 0.35-0.62）。疾病特异性生存的汇总 HR 为 0.28（95%CI 0.19-0.40）；无论是否调整混杂因素、HPV 检测方法或研究地点，均发现相似的效应大小。HPV 阳性 HNSCC 患者的无进展生存和无病生存均显著改善。HPV 阳性 HNSCC 和 OPSCC 患者的疾病特异性死亡率显著降低，且癌症进展或复发的可能性低于 HPV 阴性患者；这些发现对这些患者的治疗选择具有重要意义。
