Katzel Jed A, Merchant Maqdooda, Chaturvedi Anil K, Silverberg Michael J
Department of Oncology, Kaiser Permanente, Santa Clara, California.
Division of Research, Kaiser Permanente, Oakland, California.
Cancer Epidemiol Biomarkers Prev. 2015 Jun;24(6):978-84. doi: 10.1158/1055-9965.EPI-14-1416. Epub 2015 May 8.
It is unknown to what extent patient demographics, smoking, and alcohol use have contributed to changes in oropharyngeal and oral cavity cancer incidence rates.
We performed a cohort study of Kaiser Permanente health plan members, ages 20 to 89, for years 1995-2010 (n = 2.2 million annual members). Poisson Regression models estimated calendar trends in cancer rates both adjusted for and stratified by age, sex, smoking, and alcohol abuse history.
We identified 1,383 human papillomavirus (HPV)-related and 1,344 HPV-unrelated oral cavity and oropharyngeal cancer cases. With adjustment for age and sex, HPV-related cancer incidence rates increased 3.8% per year (P < 0.001) between 1995 and 2010, whereas rates for HPV-unrelated cancers decreased 2.4% per year (P < 0.001). For years 2007 to 2010, with additional adjustment for smoking and alcohol abuse, results were nonsignificant, but similar in magnitude. The increasing rates for HPV-related cancers were more prominent among nonsmokers (+14.5%) compared with smokers (-2.5%; P-interaction = 0.058). The decreased rates for HPV-unrelated sites were more prominent among those ≥ 60 years (-11.0%) compared with those <60 years (+16.8%; P-interaction = 0.006), among smokers (-9.7%) compared with nonsmokers (+8.4%; P-interaction = 0.055), and among those with an alcohol abuse history (-20.4%) compared with those without a history (+5.8%; P-interaction = 0.009).
The observed increasing HPV-related cancer rates are most evident among nonsmokers, whereas the decreasing HPV-unrelated cancer rates are least evident among younger individuals, nonsmokers, and those without an alcohol abuse history.
Continued vigilance for oropharyngeal and oral cavity cancer is warranted, including among those without traditional risk factors such as smoking and alcohol abuse.
患者人口统计学特征、吸烟和饮酒在多大程度上导致口咽癌和口腔癌发病率的变化尚不清楚。
我们对1995年至2010年期间年龄在20至89岁的凯撒医疗集团健康计划成员进行了一项队列研究（每年有220万成员）。泊松回归模型估计了根据年龄、性别、吸烟和酗酒史调整及分层后的癌症发病率的时间趋势。
我们识别出1383例与人乳头瘤病毒（HPV）相关的以及1344例与HPV不相关的口腔和口咽癌病例。在调整年龄和性别后，1995年至2010年间，与HPV相关的癌症发病率每年增长3.8%（P<0.001），而与HPV不相关的癌症发病率每年下降2.4%（P<0.001）。在2007年至2010年期间，进一步调整吸烟和酗酒因素后，结果无统计学意义，但幅度相似。与吸烟者（-2.5%；P交互作用=0.058）相比，与HPV相关的癌症发病率在不吸烟者中上升更为显著（+14.5%）。与年龄<60岁的人群（+16.8%；P交互作用=0.006）相比，与HPV不相关部位的癌症发病率下降在60岁及以上人群中更为显著（-11.0%），与不吸烟者（+8.4%；P交互作用=0.055）相比，在吸烟者中更为显著（-9.7%），与无酗酒史的人群（+5.8%；P交互作用=0.009）相比，在有酗酒史的人群中更为显著（-20.4%）。
观察到的与HPV相关的癌症发病率上升在不吸烟者中最为明显，而与HPV不相关的癌症发病率下降在年轻人群、不吸烟者和无酗酒史的人群中最不明显。
对口咽癌和口腔癌持续保持警惕是有必要的，包括在那些没有吸烟和酗酒等传统危险因素的人群中。
