Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Dtsch Arztebl Int. 2013 Mar;110(11):184-90, 190e1. doi: 10.3238/arztebl.2013.0184. Epub 2013 Mar 15.
The causal link between cervical cancer and human papilloma virus (HPV) is well known. It is now becoming clear that some types of squamous-cell carcinoma of the head and neck, particularly oropharyngeal carcinoma (OPC), are also linked to HPV infection. The development of vaccines against certain HPV genotypes has changed the management strategy for HPV-associated diseases of the uterine cervix. An analogous approach is now being considered for the prevention of HPV-associated diseases of the head and neck.
We review pertinent articles retrieved by a selective search of the literature for phase II and III trials providing evidence about a possible effect of HPV status on the survival rates of patients with OPC. Seven trials fulfilled our search criteria: four phase III trials with retrospective HPV analysis and three phase II trials with retrospective and prospective HPV analysis.
Patients with HPV-positive OPC survive significantly longer than those with HPV-negative OPC. Tobacco smoking has been identified as a negative prognostic factor in patients with either HPV-negative or HPV-positive disease.
The established treatment strategy for OPC in patients with and without the traditional risk factors (tobacco and alcohol consumption) is now being reconsidered in the light of what we have learned about the role of HPV infection. Ongoing and projected clinical trials with risk-factor stratification may soon lead to changes in treatment. Further study is needed to answer the question whether HPV infection in the head and neck region is carcinogenic.
宫颈癌与人类乳头瘤病毒（HPV）之间的因果关系是众所周知的。现在越来越清楚的是，某些类型的头颈部鳞状细胞癌，特别是口咽癌（OPC），也与 HPV 感染有关。针对某些 HPV 基因型的疫苗的开发改变了针对 HPV 相关宫颈疾病的管理策略。目前正在考虑类似的方法来预防 HPV 相关的头颈部疾病。
我们对文献进行了选择性搜索，检索了关于 HPV 状态对头颈癌患者生存率可能产生影响的 II 期和 III 期试验的相关文章，并对其进行了回顾。有七个试验符合我们的搜索标准：四项 III 期试验进行了 HPV 分析的回顾性研究，三项 II 期试验进行了 HPV 分析的回顾性和前瞻性研究。
HPV 阳性 OPC 患者的生存率明显高于 HPV 阴性 OPC 患者。吸烟已被确定为 HPV 阴性或阳性疾病患者的预后不良因素。
目前针对有或没有传统危险因素（烟草和酒精摄入）的 OPC 患者的既定治疗策略，正在根据我们对 HPV 感染作用的了解进行重新考虑。正在进行的和预计的临床试验对危险因素进行分层，可能很快会导致治疗方式的改变。需要进一步研究来回答头颈部区域的 HPV 感染是否具有致癌性的问题。
