Skillington S Andrew, Kallogjeri Dorina, Lewis James S, Piccirillo Jay F
Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.
Department of Pathology and Immunology, Washington University School of Medicine in St Louis, St Louis, Missouri3Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA Otolaryngol Head Neck Surg. 2016 Jun 1;142(6):568-75. doi: 10.1001/jamaoto.2016.0347.
Comorbidity affects the prognosis of patients with cancer through the direct effects of the comorbid illness and by influencing the patients' ability to tolerate treatment and mount a host response. However, the prognostic importance of comorbidity in oropharyngeal squamous cell carcinoma is not well characterized in the era of human papillomavirus infection.
To determine the prognostic importance of comorbidity in both p16-positive and p16-negative oropharyngeal squamous cell carcinoma and to explore the relationship between comorbidity and p16.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 305 patients at a single tertiary referral center diagnosed as having oropharyngeal squamous cell carcinoma between June 1996 and June 2010, but without a history of head and neck cancer or distant metastasis at time of diagnosis. The data were analyzed from August 1, 2014, through April 30, 2015.
Patients were grouped according to p16 status.
Overall survival, defined as the time from diagnosis to death from any cause. Disease-free survival, defined as the time from diagnosis to either death from any cause or the first documented local, regional, or distant recurrence.
Of the 305 patients who met eligibility criteria, 230 were p16-positive, 70 were p16-negative, and 5 were not evaluable for p16 status. The final cohort of 300 patients had a mean (SD) age of 56.3 (9.3) years and 262 (87%) were male. In Kaplan-Meier analysis, the 5-year overall survival rates were 71% (95% CI, 65%-76%) for 232 patients with no comorbidity to mild comorbidity and 49% (95% CI, 36%-61%) for 63 patients with moderate to severe comorbidity. In multivariate Cox proportional hazards analysis, moderate to severe comorbidity was associated with an increased risk of death from any cause (adjusted hazards ratio [aHR], 1.52 [95% CI, 0.99-2.32]) and increased risk of death or recurrence (aHR, 1.71 [95% CI, 1.13-2.59]). After stratifying by p16 status and controlling for other variables, moderate to severe comorbidity was significantly associated with increased risk of death from any cause among p16-negative patients (aHR, 1.90 [95% CI, 1.03-3.50]) but not among p16-positive patients (aHR, 1.11 [95% CI, 0.61-2.02]).
Comorbidity is important to consider when assessing the prognosis of patients with oropharyngeal squamous cell carcinoma and is of greater prognostic value in p16-negative than p16-positive cancer.
合并症通过合并疾病的直接影响以及影响患者耐受治疗和产生宿主反应的能力，进而影响癌症患者的预后。然而，在人乳头瘤病毒感染时代，合并症在口咽鳞状细胞癌中的预后重要性尚未得到充分描述。
确定合并症在p16阳性和p16阴性口咽鳞状细胞癌中的预后重要性，并探讨合并症与p16之间的关系。
设计、地点和参与者：对一家三级转诊中心的305例患者进行回顾性队列研究，这些患者在1996年6月至2010年6月期间被诊断为口咽鳞状细胞癌，但在诊断时无头颈癌或远处转移史。数据于2014年8月1日至2015年4月30日进行分析。
患者根据p16状态分组。
总生存期，定义为从诊断到因任何原因死亡的时间。无病生存期，定义为从诊断到因任何原因死亡或首次记录的局部、区域或远处复发的时间。
在符合纳入标准的305例患者中，230例为p16阳性，70例为p16阴性，5例无法评估p16状态。最终的300例患者队列的平均（标准差）年龄为56.3（9.3）岁，262例（87%）为男性。在Kaplan-Meier分析中，232例无合并症至轻度合并症患者的5年总生存率为71%（95%CI，65%-76%），63例中度至重度合并症患者的5年总生存率为49%（95%CI，36%-61%）。在多变量Cox比例风险分析中，中度至重度合并症与任何原因导致的死亡风险增加相关（调整后风险比[aHR]，1.52[95%CI，0.99-2.32]），以及死亡或复发风险增加相关（aHR，1.71[95%CI，1.13-2.59]）。在按p16状态分层并控制其他变量后，中度至重度合并症与p16阴性患者中任何原因导致的死亡风险增加显著相关（aHR，1.90[95%CI，1.03-3.50]），但在p16阳性患者中不相关（aHR，1.11[95%CI，0.61-2.02]）。
在评估口咽鳞状细胞癌患者的预后时，合并症是一个重要的考虑因素，并且在p16阴性癌症中比p16阳性癌症具有更大的预后价值。
