Wang Marilene B, Liu Isabelle Y, Gornbein Jeffrey A, Nguyen Chau T
Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
Otolaryngol Head Neck Surg. 2015 Nov;153(5):758-69. doi: 10.1177/0194599815592157. Epub 2015 Jun 29.
Human papillomavirus-positive (HPV+) head and neck squamous cell carcinoma is increasing in incidence and appears to exhibit improved response to treatment and better survival than that of HPV- head and neck squamous cell carcinoma. The purpose of this systematic review was to examine the current literature regarding treatment and prognosis of HPV+ oropharyngeal squamous cell carcinoma (OPSCC) and identify whether type of treatment (primarily surgery vs primarily radiation) significantly affects survival rates.
PubMed and Cochrane Library databases.
A computerized search of the PubMed and Cochrane Library databases was performed to identify English-language articles published between January 1, 2000, and October 21, 2014. Studies were included only if they were prospective or retrospective observational series of OPSCC patients that reported HPV status, treatment regimen, and survival outcomes. Outcomes were determined for HPV+ and HPV- OPSCC patients, with subanalyses according to the type of treatment received.
Fifty-six articles were eligible for this review. In the HPV+ analysis, the unadjusted hazard rate ratio (HR) for surgery vs radiation treatment was 1.33 (P = .114). Nine confounders were considered, and HRs were adjusted for each covariate. While HRs were almost all >1 for all covariates, none of the HRs was statistically significant at P < .05. The HR for HPV- OPSCC was higher for radiation than surgery.
HPV+ OPSCC has an improved prognosis and lower rates of adverse events when compared with HPV- OPSCC. HPV- OPSCC had significantly worse outcomes when treated with primary radiation as compared with primary surgery. There was no statistically significant difference in HRs for HPV+ OPSCC with primary radiation vs primary surgery treatment.
人乳头瘤病毒阳性（HPV+）头颈部鳞状细胞癌的发病率正在上升，并且似乎比HPV阴性头颈部鳞状细胞癌对治疗的反应更好，生存率更高。本系统评价的目的是研究有关HPV+口咽鳞状细胞癌（OPSCC）治疗和预后的当前文献，并确定治疗类型（主要是手术与主要是放疗）是否显著影响生存率。
PubMed和Cochrane图书馆数据库。
对PubMed和Cochrane图书馆数据库进行计算机检索，以识别2000年1月1日至2014年10月21日发表的英文文章。仅纳入那些报告了HPV状态、治疗方案和生存结局的OPSCC患者的前瞻性或回顾性观察系列研究。确定了HPV+和HPV-OPSCC患者的结局，并根据接受的治疗类型进行亚组分析。
56篇文章符合本评价的纳入标准。在HPV+分析中，手术与放射治疗的未调整风险率比（HR）为1.33（P = 0.114）。考虑了9个混杂因素，并对每个协变量进行了HR调整。虽然所有协变量的HR几乎都>1，但没有一个HR在P < 0.05时具有统计学意义。HPV-OPSCC放射治疗的HR高于手术治疗。
与HPV-OPSCC相比，HPV+OPSCC预后更好，不良事件发生率更低。与原发性手术相比，HPV-OPSCC接受原发性放射治疗时结局明显更差。HPV+OPSCC原发性放射治疗与原发性手术治疗的HR没有统计学显著差异。
