Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States.
Oral Oncol. 2018 Nov;86:69-74. doi: 10.1016/j.oraloncology.2018.09.007. Epub 2018 Sep 15.
We sought to further define prognostic and predictive value of human papillomavirus (HPV) status in metastatic squamous cell carcinoma of the oropharynx (OPC).
A Surveillance, Epidemiology, and End Results custom database identified 5940 adult patients, >18-years-old, with primary SCCHN and known HPV status, diagnosed from 2013 to 2014. Wilcoxon rank-sum and Mantel-Haenszel χ tests compared distributions of continuous and categorical covariates. Fine-Gray competing risks regressions estimated hazard ratios by HPV status, and predictive analyses were performed including the interaction term HPV status × Receipt of Chemotherapy.
182 of 5940 patients (4.0%) had metastatic OPC at diagnosis (106/3925 [2.7%] HPV+ and 76/1894 [4.0%] HPV-). HPV+ disease was prognostic for improved 20-month cancer-specific mortality (CSM) (47.1% vs 72.5%, HR 0.43, 95% CI 0.26-0.74, p = 0.002) on univariable analysis. HPV status was predictive of response to chemotherapy-adjusted HRs for receipt of chemotherapy were 0.11 (95% CI 0.03-0.37) and 0.34 (95% CI 0.18-0.64) for HPV+ versus HPV- disease, respectively (P = 0.036).
HPV status has known prognostic value in locally advanced OPC, but data on metastatic OPC are sparse. In this work, we demonstrate that HPV status is strongly prognostic for CSM in metastatic OPC and show for the first time that HPV status predicts for response to chemotherapy.
我们旨在进一步确定人乳头瘤病毒（HPV）状态在转移性口咽鳞状细胞癌（OPC）中的预后和预测价值。
利用监测、流行病学和最终结果定制数据库，确定了 5940 名年龄大于 18 岁、患有原发性 SCCHN 且已知 HPV 状态的成年患者，其诊断时间为 2013 年至 2014 年。采用 Wilcoxon 秩和检验和 Mantel-Haenszel χ2 检验比较连续和分类协变量的分布。采用 Fine-Gray 竞争风险回归估计 HPV 状态的风险比，并进行预测分析，包括 HPV 状态×接受化疗的交互项。
5940 例患者中有 182 例（4.0%）在诊断时患有转移性 OPC（106/3925[2.7%]HPV+和 76/1894[4.0%]HPV-）。HPV+疾病对 20 个月癌症特异性死亡率（CSM）的改善具有预后意义（47.1%比 72.5%，HR 0.43，95%CI 0.26-0.74，p=0.002），这在单变量分析中是如此。HPV 状态对化疗调整后的反应具有预测价值，HPV+与 HPV-疾病相比，接受化疗的调整 HR 分别为 0.11（95%CI 0.03-0.37）和 0.34（95%CI 0.18-0.64）（p=0.036）。
HPV 状态在局部晚期 OPC 中有已知的预后价值，但转移性 OPC 的相关数据较少。在这项工作中，我们证明 HPV 状态在转移性 OPC 中对 CSM 具有强烈的预后意义，并首次表明 HPV 状态可预测对化疗的反应。
