Weller Michael A, Ward Matthew C, Berriochoa Camille, Reddy Chandana A, Trosman Samuel, Greskovich John F, Nwizu Tobenna I, Burkey Brian B, Adelstein David J, Koyfman Shlomo A
Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.
Head Neck. 2017 May;39(5):940-946. doi: 10.1002/hed.24711. Epub 2017 Feb 11.
Human papillomavirus (HPV)-positive oropharyngeal cancer is associated with favorable outcomes, prompting investigations into treatment deintensification. The purpose of this study was for us to present the predictors of distant metastases in patients with HPV-positive oropharyngeal cancer treated with cisplatin-based chemoradiotherapy (CRT) or cetuximab-based bioradiotherapy (bio-RT).
In patients with stage III to IVb HPV-positive oropharyngeal cancer, the Kaplan-Meier analysis was used to calculate distant metastases rates. Univariate analysis (UVA) and multivariate analysis (MVA) were used to identify factors associated with distant metastases.
Increased distant metastases rates were noted in active smokers versus never/former smokers (22% vs 5%), T4 vs T1 to T3 (15% vs 6%), and cetuximab-based bio-RT versus CRT (23% vs 5%). All remained significant on MVA.
T4 tumors and active smokers have substantial rates of distant metastases, and trials investigating intensified systemic therapies may be considered. Higher rates of distant metastases observed with concurrent cetuximab are hypothesis generating, but further data are needed. © 2017 Wiley Periodicals, Inc. Head Neck 39: 940-946, 2017.
人乳头瘤病毒（HPV）阳性的口咽癌预后良好，这促使人们对治疗方案简化进行研究。本研究的目的是呈现接受基于顺铂的放化疗（CRT）或基于西妥昔单抗的生物放疗（bio-RT）的HPV阳性口咽癌患者远处转移的预测因素。
对于III至IVb期HPV阳性口咽癌患者，采用Kaplan-Meier分析计算远处转移率。单因素分析（UVA）和多因素分析（MVA）用于确定与远处转移相关的因素。
现吸烟者与从不吸烟/既往吸烟者相比，远处转移率增加（22%对5%），T4期与T1至T3期相比（15%对6%），基于西妥昔单抗的bio-RT与CRT相比（23%对5%）。在多因素分析中所有这些因素仍具有显著性。
T4期肿瘤患者和现吸烟者有较高的远处转移率，可考虑开展强化全身治疗的试验。同时使用西妥昔单抗时观察到较高的远处转移率，这有待进一步研究，但还需要更多数据。©2017威利期刊公司。《头颈》39: 940 - 946, 2017年。
