Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
Department of Radiation Oncology, School of Medicine, Emory University, Atlanta, Georgia.
Cancer. 2018 Aug 1;124(15):3163-3170. doi: 10.1002/cncr.31537. Epub 2018 May 9.
Human papillomavirus (HPV) infection has contributed to an increased incidence of squamous cell carcinoma of the head and neck (SCCHN). Fatigue is a major side effect of SCCHN and its treatment. However, to the authors' knowledge, the association between HPV and fatigue has not been examined to date, nor is it known whether HPV influences biological mechanisms of fatigue, including inflammation.
Patients with SCCHN who were without distant metastasis were assessed at baseline (pre-radiotherapy) and 1 month and 3 months postradiotherapy. Fatigue was measured using the Multidimensional Fatigue Inventory. Peripheral inflammation was assessed by plasma C-reactive protein (CRP), interleukin 1 receptor antagonist (IL-1ra), soluble tumor necrosis factor receptor 2 (sTNFR2), and IL-6. Mixed effect models were used to examine associations.
A total of 94 patients who were newly diagnosed were enrolled; 53% had HPV-related tumors. Patients with HPV-unrelated tumors had higher fatigue and higher plasma CRP, sTNFR2, and IL-6 over time, especially at baseline and 3 months after intensity-modulated radiotherapy compared with those with HPV-related tumors (all P < .05). However, fatigue and plasma sTNFR2 increased more significantly from baseline to 1 month after radiotherapy in the HPV-related group compared with the HPV-unrelated group (both P < .01). Controlling for significant covariates, HPV status and inflammation were found to be independent predictors of fatigue over time.
HPV status is an important marker of vulnerability to the behavioral and immune consequences of SCCHN and its treatment, providing support for different symptom management strategies. Special emphasis should be placed on addressing marked persistent fatigue in patients with HPV-unrelated tumors, whereas attention should be paid to the large increases in fatigue during treatment among patients with HPV-related tumors. Cancer 2018. © 2018 American Cancer Society.
人乳头瘤病毒（HPV）感染导致头颈部鳞状细胞癌（SCCHN）的发病率增加。疲劳是 SCCHN 及其治疗的主要副作用。然而，据作者所知，迄今为止尚未研究 HPV 与疲劳之间的关系，也不知道 HPV 是否会影响包括炎症在内的疲劳的生物学机制。
在放疗前（基线）和放疗后 1 个月和 3 个月，评估无远处转移的 SCCHN 患者。使用多维疲劳量表（Multidimensional Fatigue Inventory）评估疲劳。通过血浆 C 反应蛋白（CRP）、白细胞介素 1 受体拮抗剂（IL-1ra）、可溶性肿瘤坏死因子受体 2（sTNFR2）和白细胞介素 6 评估外周炎症。采用混合效应模型来检验相关性。
共纳入 94 例新诊断患者，其中 53%为 HPV 相关肿瘤。与 HPV 相关肿瘤患者相比，无 HPV 相关肿瘤患者的疲劳程度更高，血浆 CRP、sTNFR2 和 IL-6 水平随时间升高，尤其是在调强放疗基线和 3 个月时（均 P <.05）。然而，与 HPV 无关的肿瘤组相比，HPV 相关肿瘤组从基线到放疗后 1 个月，疲劳和血浆 sTNFR2 增加更为显著（均 P <.01）。控制重要协变量后，HPV 状态和炎症被发现是随时间推移疲劳的独立预测因子。
HPV 状态是 SCCHN 及其治疗行为和免疫后果易感性的重要标志物，为不同的症状管理策略提供支持。应特别注意解决无 HPV 相关肿瘤患者明显的持续性疲劳，而应注意 HPV 相关肿瘤患者在治疗期间疲劳的大幅增加。癌症 2018。© 2018 美国癌症协会。
