Thibaudeau E, Fortin B, Coutlée F, Nguyen-Tan P, Weng X, Audet M-L, Abboud O, Guertin L, Christopoulos A, Tabet J, Soulières D
Department of Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, 1560 Sherbrooke Est, Montreal (Quebec), Canada H2L 4M1.
Int J Otolaryngol. 2013;2013:437815. doi: 10.1155/2013/437815. Epub 2013 Apr 24.
Background. HPV is a positive prognostic factor in HNSCC. We studied the prevalence and prognostic impact of HPV on survival parameters and treatment toxicity in patients with locally advanced HNSCC treated with concomitant chemoradiation therapy. Methods. Data on efficacy and toxicity were available for 560 patients. HPV was detected by PCR. Analysis was performed using Kaplan-Meier survival curves, Fisher's test for categorical data, and log-rank statistics for failure times. Results. Median follow-up was 4.7 years. DNA extraction was successful in 255 cases. HPV prevalence was 68.6%, and 53.3% for HPV 16. For HPV+ and HPV-, median LRC was 8.9 and 2.2 years (P = 0.0002), median DFS was 8.9 and 2.1 years (P = 0.0014), and median OS was 8.9 and 3.1 years (P = 0.0002). Survival was different based on HPV genotype, stage, treatment period, and chemotherapy regimen. COX adjusted analysis for T, N, age, and treatment remained significant (P = 0.004). Conclusions. Oropharyngeal cancer is increasingly linked to HPV. This study confirms that HPV status is associated with improved prognosis among H&N cancer patients receiving CRT and should be a stratification factor for clinical trials including H&N cases. Toxicity of CRT is not modified for the HPV population.
背景。人乳头瘤病毒（HPV）是头颈部鳞状细胞癌（HNSCC）的一个阳性预后因素。我们研究了HPV在接受同步放化疗的局部晚期HNSCC患者中的患病率及其对生存参数和治疗毒性的预后影响。方法。560例患者有疗效和毒性数据。通过聚合酶链反应（PCR）检测HPV。使用Kaplan-Meier生存曲线、分类数据的Fisher检验以及失败时间的对数秩统计进行分析。结果。中位随访时间为4.7年。255例成功提取DNA。HPV患病率为68.6%，HPV 16为53.3%。HPV阳性（HPV+）和HPV阴性（HPV-）患者的中位局部区域控制时间（LRC）分别为8.9年和2.2年（P = 0.0002），中位无病生存期（DFS）分别为8.9年和2.1年（P = 0.0014），中位总生存期（OS）分别为8.9年和3.1年（P = 0.0002）。生存情况因HPV基因型、分期、治疗时期和化疗方案而异。对T、N、年龄和治疗进行COX调整分析后仍具有显著性（P = 0.004）。结论。口咽癌与HPV的关联日益增加。本研究证实，HPV状态与接受同步放化疗的头颈部癌症患者预后改善相关，应作为包括头颈部病例的临床试验的分层因素。同步放化疗对HPV人群的毒性无影响。
