Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Oral Oncol. 2018 Nov;86:121-131. doi: 10.1016/j.oraloncology.2018.09.018. Epub 2018 Sep 20.
The optimal management of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) with primary surgical versus non-surgical treatment is unclear. The objective of this systematic review was to evaluate the literature and compare survival for primary surgical versus non-surgical treatment of HPV-positive OPSCC. We performed a comprehensive literature search of multiple electronic databases for relevant articles up to February, 2017. Studies reporting mortality or hazard ratio (HR) for overall survival (OS) in primary HPV-positive OPSCC patients were eligible. Seventy-three articles were eligible, of which 66 included single-modality (19 surgical, 47 non-surgical), and 7 included both surgical and non-surgical modalities. There were no randomized studies comparing outcomes between both modalities. In a meta-analysis of both-modality studies, OS with surgical treatment was not significantly different from non-surgical treatment (pooled HR 1.12; 95% CI: 0.35, 3.57). There was significant heterogeneity between studies (I = 82.4%). Among single-modality studies, the mortality rate was lower with surgical [pooled proportion 0.15 (95% CI: 0.09, 0.21)] versus non-surgical treatment [0.20 (95% CI:0.15, 0.24)]. In a subgroup analysis, OS was higher for HPV-positive versus HPV-negative OPSCC, irrespective of the treatment modality. We conclude that there is an absence of high-quality studies that compare survival for HPV-positive OPSCC treated with primary surgical versus non-surgical approach. The available data suggest no statistical or clinically meaningful difference in survival between the two approaches. HPV-positivity was a key prognostic factor irrespective of treatment modality. Further high-quality studies with consistent data reporting are needed to inform the choice for optimal treatment modality for HPV-positive OPSCC.
人乳头瘤病毒（HPV）阳性口咽鳞状细胞癌（OPSCC）的最佳治疗方法是手术治疗还是非手术治疗尚不清楚。本系统评价的目的是评估文献并比较 HPV 阳性 OPSCC 患者的主要手术治疗与非手术治疗的生存情况。我们对多个电子数据库进行了全面的文献检索，以查找截至 2017 年 2 月的相关文章。报告 HPV 阳性 OPSCC 患者死亡率或总生存率（OS）风险比（HR）的研究符合纳入标准。有 73 篇文章符合条件，其中 66 篇为单一治疗模式（19 例手术，47 例非手术），7 篇为手术和非手术联合治疗模式。没有比较两种治疗模式的随机研究。在联合治疗模式的荟萃分析中，手术治疗的 OS 与非手术治疗无显著差异（汇总 HR 1.12；95%CI：0.35，3.57）。研究之间存在显著的异质性（I=82.4%）。在单一治疗模式研究中，手术治疗的死亡率低于非手术治疗（汇总比例 0.15（95%CI：0.09，0.21））[0.20（95%CI：0.15，0.24）]。亚组分析显示，HPV 阳性 OPSCC 的 OS 高于 HPV 阴性 OPSCC，不论治疗方式如何。我们的结论是，目前缺乏高质量的研究比较 HPV 阳性 OPSCC 患者的主要手术治疗与非手术治疗的生存情况。现有数据表明，两种治疗方法在生存方面没有统计学或临床意义上的差异。HPV 阳性是一个关键的预后因素，与治疗方式无关。需要进一步开展高质量的研究，并报告一致的数据，为 HPV 阳性 OPSCC 的最佳治疗方式提供依据。
