Verma Vivek, Simone Charles B, Lin Chi
Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland.
Head Neck. 2018 Apr;40(4):696-706. doi: 10.1002/hed.24978. Epub 2018 Jan 11.
There are no existing high-volume studies characterizing human papillomavirus (HPV)-associated nasopharyngeal cancer (NPC).
The National Cancer Data Base (NCDB) was queried for NPC with known HPV (2004-2013). Logistic regression ascertained factors associated with HPV-positivity. Kaplan-Meier overall survival (OS) was evaluated between HPV-positive and HPV-negative cohorts; Cox proportional hazards modeling assessed factors associated with OS. Patients with nonmetastatic disease receiving definitive chemoradiotherapy underwent propensity-matched OS analysis.
Altogether, 956 patients were analyzed (32% HPV-positive and 68% HPV-negative). Median follow-up was 23 months (range 0-67 months). The patients with HPV-positive disease were younger, less likely to be uninsured, lived in more educated areas, and presented with more advanced T (but not N/overall) classification. Median OS for HPV-positive and HPV-negative groups were 50 and 43 months, respectively (P = .171). The HPV status did not independently predict for OS (P = .183). No OS differences were observed after propensity matching (P = .734).
In what we believe as the only large study of HPV-associated NPC, HPV neither correlates with nor predicts survival in NPC. Owing to the difficulty of addressing causality in database studies, further work must corroborate the findings herein.
目前尚无大量研究对人乳头瘤病毒（HPV）相关的鼻咽癌（NPC）进行特征描述。
查询国家癌症数据库（NCDB）中2004年至2013年已知HPV情况的鼻咽癌患者。采用逻辑回归确定与HPV阳性相关的因素。对HPV阳性和HPV阴性队列进行Kaplan-Meier总生存（OS）评估；Cox比例风险模型评估与总生存相关的因素。对接受确定性放化疗的非转移性疾病患者进行倾向匹配的总生存分析。
共分析了956例患者（32%为HPV阳性，68%为HPV阴性）。中位随访时间为23个月（范围0至67个月）。HPV阳性疾病患者更年轻，无保险的可能性更小，居住在受教育程度更高的地区，且T分期更晚（但N分期/总体分期并非如此）。HPV阳性组和HPV阴性组的中位总生存时间分别为50个月和43个月（P = 0.171）。HPV状态不能独立预测总生存（P = 0.183）。倾向匹配后未观察到总生存差异（P = 0.734）。
在我们认为是唯一一项关于HPV相关鼻咽癌的大型研究中，HPV与鼻咽癌的生存既无相关性也无预测性。由于在数据库研究中难以确定因果关系，必须有进一步的研究来证实本研究结果。
