Sydney Medical School, The University of Sydney, and Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, Australia.
Ann Oncol. 2013 Jan;24(1):215-9. doi: 10.1093/annonc/mds205. Epub 2012 Aug 10.
Despite the association with more advanced nodal stage, patients with human papillomavirus (HPV) positive oropharyngeal cancers have better outcomes. We examined whether the HPV can modify the effect of known prognostic factors in tonsillar cancer.
A total of 489 patients from 10 centres were followed up for recurrence or death for a median of 3.2 years. Determinants of the rate of locoregional recurrence, death from tonsillar cancer and overall survival were modelled using Cox regression.
The prognostic value of T and N stages were modified by HPV as indicated by statistically significant interaction terms. After adjusting for age, gender and treatment, T stage appeared relevant only for HPV-positive cancers (where a higher T stage was associated with worse outcomes). There was some evidence that N stage was a more relevant prognostic factor for HPV-negative than -positive cancers. There was no evidence that the HPV modifies the effect of age, gender or grade on outcomes.
This study suggests that the prognostic significance of the conventional staging system in tonsillar cancer is modified by HPV.
尽管与更晚期的淋巴结分期相关，但 HPV 阳性口咽癌患者的预后更好。我们研究了 HPV 是否可以改变扁桃体癌中已知预后因素的作用。
来自 10 个中心的 489 名患者接受了中位随访 3.2 年，以监测局部区域复发、扁桃体癌死亡和总生存情况。使用 Cox 回归模型确定局部区域复发率、扁桃体癌死亡和总生存率的决定因素。
HPV 改变了 T 期和 N 期的预后价值，这表明存在统计学显著的交互项。在调整年龄、性别和治疗后，T 期仅与 HPV 阳性癌症相关（高 T 期与更差的预后相关）。有一些证据表明 N 期对于 HPV 阴性癌症比阳性癌症是更相关的预后因素。没有证据表明 HPV 改变了年龄、性别或分级对结局的影响。
本研究表明，传统分期系统在扁桃体癌中的预后意义被 HPV 改变。
