Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins University, Baltimore, Maryland.
Cancer. 2019 Jan 15;125(2):249-260. doi: 10.1002/cncr.31800. Epub 2018 Nov 16.
The increasing incidence of human papillomavirus (HPV)-related head and neck cancer (HNC) has led to the increasing prevalence of survivors, yet to the best of the authors' knowledge the prevalence of comorbidities during the survivorship period and their effects on survival are relatively unknown.
In this retrospective cross-sectional study, individuals with a first incident primary diagnosis of HNC from 2004 through 2011 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked databases were included in the analysis and classified as patients with HPV-related or HPV-unrelated HNC. The presence of 30 comorbid conditions of interest was identified. Associations between comorbidity and treatment group as well as overall survival were evaluated.
The study population consisted of 8025 patients with HPV-unrelated HNC and 2499 patients with HPV-related HNC. Hypertension, congestive heart failure, cerebrovascular disease, and chronic obstructive pulmonary disease all were found to be highly prevalent at the time of the cancer diagnosis and increased over time for both groups. These comorbidities were found at significantly lower rates in the HPV-related HNC population, yet were associated with an increased risk of death in both groups. The probabilities of developing cancer-related comorbidities such as pneumonia, dysphagia, weight loss, malnutrition, and dental issues rose significantly in both groups after treatment but were more likely in patients with HPV-related HNC. In both groups of patients, the presence of each comorbidity either at the time of diagnosis or during survivorship was associated with a significantly increased risk of death.
There is a large burden of comorbidities in both patients with HPV-related and HPV-unrelated HNC, both of which are associated with decreased survival. Oncologic surveillance should not be limited to the evaluation of disease status, but also should include screening for the highly prevalent conditions associated with the risk of death.
人乳头瘤病毒（HPV）相关头颈部癌症（HNC）的发病率不断增加，导致幸存者的数量不断增加，但据作者所知，在生存期间合并症的流行情况及其对生存的影响尚不清楚。
在这项回顾性的横断面研究中，分析了来自 2004 年至 2011 年监测、流行病学和最终结果（SEER）-医疗保险相关数据库的首次发生原发性 HNC 个体，并将其分为 HPV 相关或 HPV 不相关 HNC 患者。确定了 30 种感兴趣的合并症。评估了合并症与治疗组以及总生存率之间的关系。
研究人群包括 8025 例 HPV 不相关 HNC 患者和 2499 例 HPV 相关 HNC 患者。高血压、充血性心力衰竭、脑血管疾病和慢性阻塞性肺疾病在癌症诊断时均高度流行，并在两组中随时间推移而增加。这些合并症在 HPV 相关 HNC 人群中的发生率明显较低，但与两组的死亡风险增加相关。在两组患者中，治疗后发生肺炎、吞咽困难、体重减轻、营养不良和牙科问题等癌症相关合并症的概率均显著增加，但在 HPV 相关 HNC 患者中更为常见。在两组患者中，无论是在诊断时还是在生存期间存在任何一种合并症，都与死亡风险显著增加相关。
HPV 相关和 HPV 不相关 HNC 患者都存在大量合并症，两者都与生存率降低有关。肿瘤监测不应仅限于评估疾病状况，还应包括筛查与死亡风险相关的高流行疾病。
