Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Radiation Oncology, Osaka University School of Medicine, Suita, Osaka, Japan.
Int J Clin Oncol. 2019 Jun;24(6):640-648. doi: 10.1007/s10147-019-01394-1. Epub 2019 Jan 29.
Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) is defined by p16 positivity and/or HPV DNA positivity. Because survival of patients with HPV-related OPSCC after chemoradiotherapy is favorable, a de-intensified treatment is expected to lead to less morbidity while maintaining low mortality. The association of tumor p16 and HPV DNA status with survival after radiotherapy alone remains unknown.
We retrospectively examined survival of 107 patients with locally advanced OPSCC after radiotherapy alone (n = 43) or chemoradiotherapy (n = 64) with respect to tumor p16 and HPV DNA status, using Cox's proportional hazard model.
Survival after radiotherapy alone was significantly worse in p16-positive/HPV DNA-negative locally advanced OPSCC than in p16-positive/HPV DNA-positive locally advanced OPSCC. In bivariable analyses that included T category, N category, TNM stage, and smoking history, the survival disadvantage of p16-positive/HPV DNA-negative locally advanced OPSCC remained significant. There was no significant difference in survival after chemoradiotherapy between p16-positive/HPV DNA-positive locally advanced OPSCC and p16-positive/HPV DNA-negative locally advanced OPSCC. Survival in p16-positive/HPV DNA-positive locally advanced OPSCC after radiotherapy alone was similar to that after chemoradiotherapy, which stayed unchanged in bivariable analyses after adjustment of every other covariable. Survival of p16-negative/HPV DNA-negative locally advanced OPSCC was poor irrespective of treatment modality.
Survival in p16-positive locally advanced OPSCC differs depending on HPV DNA status. Radiotherapy alone can serve as a de-intensified treatment for p16-positive/HPV DNA-positive locally advanced OPSCC, but not for p16-positive/HPV DNA-negative locally advanced OPSCC.
人乳头瘤病毒（HPV）相关的口咽鳞状细胞癌（OPSCC）的定义是 p16 阳性和/或 HPV DNA 阳性。由于接受放化疗的 HPV 相关 OPSCC 患者的生存率较好，因此预计减量化治疗在保持低死亡率的同时可减少发病率。单独放疗后肿瘤 p16 和 HPV DNA 状态与生存率之间的关联尚不清楚。
我们使用 Cox 比例风险模型，回顾性地分析了 107 例接受单纯放疗（n=43）或放化疗（n=64）的局部晚期 OPSCC 患者的生存情况，分别考虑了肿瘤 p16 和 HPV DNA 状态。
与 p16 阳性/HPV DNA 阳性的局部晚期 OPSCC 相比，p16 阳性/HPV DNA 阴性的局部晚期 OPSCC 单独接受放疗后的生存率显著更差。在包括 T 分期、N 分期、TNM 分期和吸烟史在内的单变量分析中，p16 阳性/HPV DNA 阴性的局部晚期 OPSCC 生存劣势仍然显著。p16 阳性/HPV DNA 阳性的局部晚期 OPSCC 在接受放化疗后的生存率无显著差异，且在调整其他每个协变量后的双变量分析中保持不变。p16 阳性/HPV DNA 阳性的局部晚期 OPSCC 单独接受放疗后的生存率与接受放化疗后的生存率相似，且在调整其他每个协变量后的双变量分析中保持不变。p16 阴性/HPV DNA 阴性的局部晚期 OPSCC 的生存率较差，与治疗方式无关。
p16 阳性的局部晚期 OPSCC 的生存率取决于 HPV DNA 状态。单独放疗可以作为 p16 阳性/HPV DNA 阳性的局部晚期 OPSCC 的减量化治疗方法，但不能用于 p16 阳性/HPV DNA 阴性的局部晚期 OPSCC。
