Fakhry Carole, Andersen Klaus K, Christensen Jane, Agrawal Nishant, Eisele David W
Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland. Milton J. Dance Jr. Head and Neck Center, Baltimore, Maryland.
Danish Cancer Society Research Center, Statistics, Bioinformatics and Registry Unit, Copenhagen, Denmark.
Cancer Prev Res (Phila). 2015 Jul;8(7):583-9. doi: 10.1158/1940-6207.CAPR-15-0101. Epub 2015 Apr 20.
The incidence of oropharyngeal carcinoma, involving palatine and lingual tonsils, is increasing globally. This significant rise is driven by human papillomavirus. Whether palatine tonsillectomy affects risk of diagnosis with oropharyngeal carcinoma is unknown. The association between tonsillectomy and incidence of oropharyngeal carcinoma was explored in the Danish Cancer Registry. The association between tonsillectomy and oropharyngeal carcinoma was analyzed by time since first registration of tonsillectomy. Tonsillectomy was a time-dependent variable. Individuals were censored for death, emigration, or tonsillectomy within incident year of diagnosis. Incidence rate ratios (RR) were estimated by Poisson regression models and adjusted for confounders. Kaplan-Meier survival analyses were compared by the log-rank test, and HRs were estimated by Cox proportional hazards models. From 1977 to 2012, the incidence of tonsillectomies significantly decreased, whereas the incidence of oropharyngeal carcinoma significantly increased. Tonsillectomy was not associated with risk of oropharyngeal carcinoma or malignancies of other anatomic sites, including base of tongue. However, tonsillectomy significantly reduced risk of diagnosis with tonsil carcinoma [RR, 0.40; 95% confidence interval (CI), 0.22-0.70]. The risk of diagnosis with tonsil carcinoma at age <60 years was significantly decreased (RRadj, 0.15; 95% CI, 0.06-0.41) after tonsillectomy. Tonsillectomy within 1 year of diagnosis with tonsil carcinoma was associated with significantly improved overall survival (HR, 0.53; 95% CI, 0.38-0.74). In conclusion, remote history of tonsillectomy reduces the risk of diagnosis with tonsil carcinoma. These data inform risk and benefit of tonsillectomy, a common procedure and design of secondary prevention trials.
口咽癌（累及腭扁桃体和舌扁桃体）的发病率在全球范围内呈上升趋势。这一显著上升是由人乳头瘤病毒驱动的。腭扁桃体切除术是否会影响口咽癌的诊断风险尚不清楚。我们在丹麦癌症登记处探讨了扁桃体切除术与口咽癌发病率之间的关联。根据扁桃体切除术首次登记后的时间分析扁桃体切除术与口咽癌之间的关联。扁桃体切除术是一个随时间变化的变量。在诊断的发病年份内，个体因死亡、移民或扁桃体切除术而被截尾。发病率比（RR）通过泊松回归模型估计，并对混杂因素进行调整。通过对数秩检验比较Kaplan-Meier生存分析，并通过Cox比例风险模型估计风险比（HR）。从1977年到2012年，扁桃体切除术的发病率显著下降，而口咽癌的发病率显著上升。扁桃体切除术与口咽癌或其他解剖部位（包括舌根）的恶性肿瘤风险无关。然而，扁桃体切除术显著降低了扁桃体癌的诊断风险[RR，0.40；95%置信区间（CI），0.22 - 0.70]。扁桃体切除术后，年龄<60岁的患者患扁桃体癌的诊断风险显著降低（校正RR，0.15；95% CI，0.06 - 0.41）。在诊断为扁桃体癌后一年内进行扁桃体切除术与总体生存率显著提高相关（HR，0.53；95% CI，0.38 - 0.74）。总之，既往扁桃体切除术史可降低扁桃体癌的诊断风险。这些数据为扁桃体切除术（一种常见手术）的风险和益处以及二级预防试验的设计提供了信息。
