Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada; Sainte-Justine Hospital Research Center, Montreal, QC, Canada.
Institut Català d'Oncologia (ICO) - Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
Lancet Oncol. 2014 Nov;15(12):1319-31. doi: 10.1016/S1470-2045(14)70471-1. Epub 2014 Oct 16.
We aimed to provide updated information about the global estimates of attributable fraction and type distribution of human papillomavirus (HPV) in head and neck squamous cell carcinomas by doing a systematic review and meta-analysis.
We did a literature search on PubMed to identify studies that used PCR for detection of HPV DNA in head and neck squamous cell carcinomas with information about HPV genotype distribution. We included studies that tested 20 or more biopsies per cancer site and were published between July 15, 1990, and Feb 29, 2012. We collected information about sex, risk factors, HPV detection methods, and biomarkers of potentially HPV-induced carcinogenesis (E6/E7 mRNA and p16(INK4a)). If it was not possible to abstract the required information directly from the paper, we contacted the authors. We did a meta-analysis to produce pooled prevalence estimates including a meta-regression to explore sources of heterogeneity.
148 studies were included, contributing data for 12 163 cases of head and neck squamous cell carcinoma from 44 countries. HPV DNA was detected in 3837 cases. HPV16 accounted for 82·2% (95% CI 77·7-86·4) of all HPV DNA positive cases. By cancer site, pooled HPV DNA prevalence estimates were 45·8% (95% CI 38·9-52·9) for oropharynx, 22·1% (16·4-28·3) for larynx (including hypopharynx), and 24·2% (18·7-30·2) for oral cavity. The percent positivity of p16(INK4a) positive cases in HPV-positive oropharyngeal cancer cases was 86·7% (95% CI 79·2-92·9) and of E6/E7 mRNA positive cases was 86·9% (73·2-96·8). The estimate of HPV attributable fraction in oropharyngeal cancer defined by expression of positive cases of E6/E7 mRNA was 39·8% and of p16(INK4a) was 39·7%. Of subsites, tonsils (53·9%, 95% CI 46·4-61·3) had the highest HPV DNA prevalence. HPV DNA prevalence varied significantly by anatomical site, geographic region, but not by sex or tobacco or alcohol consumption.
The contribution of HPV prevalence in head and neck squamous cell carcinoma and in particular that of HPV16 in the oropharynx shows the potential benefit of prophylactic vaccines.
European Commission.
我们旨在通过系统综述和荟萃分析，提供有关人乳头瘤病毒（HPV）在头颈部鳞状细胞癌中的全球归因分数和类型分布的最新信息。
我们在 PubMed 上进行了文献检索，以确定使用聚合酶链反应（PCR）检测头颈部鳞状细胞癌中 HPV DNA 并具有 HPV 基因型分布信息的研究。我们纳入了对每个癌症部位检测 20 个或更多活检且发表于 1990 年 7 月 15 日至 2012 年 2 月 29 日之间的研究。我们收集了有关性别、危险因素、HPV 检测方法以及 HPV 诱导致癌的潜在生物标志物（E6/E7 mRNA 和 p16(INK4a)）的信息。如果无法直接从论文中提取所需信息，我们会联系作者。我们进行了荟萃分析，生成了包括荟萃回归在内的汇总流行率估计值，以探索异质性的来源。
纳入了 148 项研究，共纳入了来自 44 个国家的 12163 例头颈部鳞状细胞癌病例的数据。在 3837 例病例中检测到 HPV DNA。HPV16 占所有 HPV DNA 阳性病例的 82.2%（95%CI 77.7-86.4）。按癌症部位分类，口咽部位 HPV DNA 总流行率估计值为 45.8%（95%CI 38.9-52.9），喉（包括下咽）为 22.1%（16.4-28.3），口腔为 24.2%（18.7-30.2）。HPV 阳性口咽癌病例中 p16(INK4a)阳性病例的阳性率为 86.7%（95%CI 79.2-92.9），E6/E7 mRNA 阳性病例的阳性率为 86.9%（73.2-96.8）。通过 E6/E7 mRNA 阳性病例表达定义的口咽癌 HPV 归因分数估计值为 39.8%，p16(INK4a)为 39.7%。在各亚部位中，扁桃体（53.9%，95%CI 46.4-61.3）的 HPV DNA 流行率最高。HPV DNA 流行率在解剖部位、地理位置上存在显著差异，但与性别、烟草或酒精消费无关。
头颈部鳞状细胞癌中 HPV 的流行率，特别是口咽部 HPV16 的流行率，表明预防性疫苗具有潜在的益处。
欧盟委员会。
