Stenmark Matthew H, Shumway Dean, Guo Cui, Vainshtein Jeffrey, Mierzwa Michelle, Jagsi Reshma, Griggs Jennifer J, Banerjee Mousumi
Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan, U.S.A.
Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, U.S.A.
Laryngoscope. 2017 Oct;127(10):2270-2278. doi: 10.1002/lary.26566. Epub 2017 Mar 17.
Much of what is known about the significance of human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma is derived from single-institution retrospective studies, post hoc analyses of tissue specimens from clinical trials, and tissue bank studies with a small sample size. The objective of this study is to investigate the impact of HPV on the frequency and clinical presentation of oropharyngeal carcinoma in a large, national sample with information from patients who underwent HPV testing.
Retrospective, cross-sectional study.
We identified a comprehensive national sample of 8,359 patients with oropharyngeal carcinoma and known HPV status diagnosed between 2010 and 2011 within the National Cancer Database. Multivariable logistic regression was used to assess correlates of patient and tumor characteristics on HPV status.
Among patients with oropharyngeal carcinoma, the frequency of HPV-related squamous cell carcinoma in the United States was 65.4%. HPV-related oropharyngeal carcinoma was associated with younger age, male sex, and white race (P < 0.001). Advanced primary tumor stage was associated with HPV-negative disease (P < 0.001), whereas increasing nodal burden was associated with HPV-positive disease (P < 0.001). Despite less-advanced nodal disease, HPV-negative tumors were associated with a higher likelihood of metastasis at presentation (P < 0.001).
HPV now accounts for the majority of newly diagnosed oropharyngeal carcinoma in the United States and is associated with a distinct clinical profile, supporting efforts to re-evaluate the staging and treatment paradigm for HPV-associated oropharyngeal cancer.
目前已知的关于人乳头瘤病毒（HPV）在口咽鳞状细胞癌中的意义，大多来自单机构回顾性研究、临床试验组织标本的事后分析以及样本量较小的组织库研究。本研究的目的是在一个来自全国的大型样本中，通过接受HPV检测患者的信息，调查HPV对口咽癌发病率及临床表现的影响。
回顾性横断面研究。
我们在国家癌症数据库中确定了一个由8359例口咽癌患者组成的全面的全国性样本，这些患者在2010年至2011年期间被诊断出HPV状态已知。采用多变量逻辑回归分析来评估患者及肿瘤特征与HPV状态之间的相关性。
在美国的口咽癌患者中，HPV相关鳞状细胞癌的发生率为65.4%。HPV相关口咽癌与年轻、男性及白人种族相关（P < 0.001）。原发肿瘤晚期与HPV阴性疾病相关（P < 0.001），而淋巴结负担增加与HPV阳性疾病相关（P < 0.001）。尽管淋巴结疾病程度较轻，但HPV阴性肿瘤在初诊时发生转移的可能性更高（P < 0.001）。
目前在美国，HPV占新诊断口咽癌的大多数，并且与独特的临床特征相关，这支持了重新评估HPV相关口咽癌分期及治疗模式的努力。
4级。《喉镜》，2017年，第127卷，第2270 - 2278页。
