Cantrell Sarah C, Reid Holly H, Li Guojun, Wei Qingyi, Sturgis Erich M, Ginsberg Lawrence E
From the *Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, †Department of Radiology, The University of Texas Health Science Center, ‡The University of Texas Medical School at Houston, Departments of §Head and Neck Surgery, ∥Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX; and ¶Duke Cancer Institute, Duke University Medical Center, Durham, NC.
J Comput Assist Tomogr. 2014 Sep-Oct;38(5):667-73. doi: 10.1097/RCT.0000000000000100.
Human papillomavirus (HPV)-positive oropharyngeal cancers represent a distinct clinical entity with more favorable prognosis than do HPV-negative oropharyngeal cancers. However, among patients with HPV-positive oropharyngeal carcinomas, those with a significant smoking history have a much worse prognosis. Recently, imaging characteristics of oropharyngeal cancers were identified as markers of poor prognosis. The purpose of this study was to determine whether nodal imaging characteristics differ between smokers and never/light smokers with HPV-positive oropharyngeal cancer.
A review of 130 pretreatment computed tomographic examinations of HPV-positive oropharyngeal cancers in smokers (>10 pack-years) and never/light smokers (10 pack-years) matched for T stage and tumor subsite was performed, with the reviewing radiologist blinded to the HPV status, smoking history, and clinical stage. Additionally 24 pretreatment computed tomographic examinations of patients with HPV-negative oropharyngeal cancers were also reviewed in a blinded fashion. Imaging characteristics of metastatic nodal disease were compared using the testing (Fisher exact testing where appropriate) and McNemar testing for the matched-pair analysis.
As expected, those with HPV-positive oropharyngeal cancer were more likely to be younger, male, non-Hispanic white, never/former smokers, and never drinkers than were those with HPV-negative oropharyngeal cancer. Furthermore, the HPV-positive oropharyngeal cancers were more likely to be in the tonsil, smaller T category, higher N category, poorly differentiated, than were the HPV-negative oropharyngeal cancers. However, among the HPV-positive oropharyngeal cancers, we could identify no obvious difference in the pretreatment imaging characteristics of paired smokers and never/light smokers.
Among the patients with HPV-positive oropharyngeal cancer, no imaging characteristics were identified to correlate with the critical prognostic feature smoking status. Cystic and necrotic nodal metastases, as described previously, were more common among the patients with HPV-positive than those with HPV-negative oropharyngeal cancers. Although cystic nodal metastases were more common among the never/light smokers with HPV-positive oropharyngeal cancer than among smokers with HPV-positive oropharyngeal cancer, however, because these results did not reach statistical significance, we concluded that the imaging results cannot serve as a surrogate for an HPV-driven phenotype.
人乳头瘤病毒（HPV）阳性的口咽癌是一种独特的临床实体，其预后比HPV阴性的口咽癌更有利。然而，在HPV阳性口咽癌患者中，有显著吸烟史的患者预后要差得多。最近，口咽癌的影像学特征被确定为预后不良的标志物。本研究的目的是确定HPV阳性口咽癌吸烟者与从不吸烟者/轻度吸烟者的淋巴结影像学特征是否存在差异。
回顾性分析130例HPV阳性口咽癌患者的治疗前计算机断层扫描检查，这些患者分为吸烟者（吸烟史>10包年）和从不吸烟者/轻度吸烟者（吸烟史<10包年），两组患者的T分期和肿瘤亚部位相匹配。阅片放射科医生对HPV状态、吸烟史和临床分期不知情。另外，还以盲法回顾性分析了24例HPV阴性口咽癌患者的治疗前计算机断层扫描检查。采用检验（适当情况下采用Fisher精确检验）和McNemar检验对配对分析中的转移性淋巴结疾病的影像学特征进行比较。
正如预期的那样，与HPV阴性口咽癌患者相比，HPV阳性口咽癌患者更可能为年轻人、男性、非西班牙裔白人、从不吸烟/曾经吸烟者且从不饮酒者。此外，与HPV阴性口咽癌相比，HPV阳性口咽癌更可能发生在扁桃体，T类别更小，N类别更高，分化程度低。然而，在HPV阳性口咽癌患者中，我们未发现配对的吸烟者与从不吸烟者/轻度吸烟者在治疗前影像学特征上有明显差异。
在HPV阳性口咽癌患者中，未发现影像学特征与关键预后因素吸烟状态相关。如先前所述，HPV阳性口咽癌患者中囊性和坏死性淋巴结转移比HPV阴性口咽癌患者更常见。尽管HPV阳性口咽癌的从不吸烟者/轻度吸烟者中囊性淋巴结转移比吸烟者更常见，但是由于这些结果未达到统计学意义，我们得出结论，影像学结果不能作为HPV驱动表型的替代指标。
