Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Oral Oncol. 2019 Dec;99:104472. doi: 10.1016/j.oraloncology.2019.104472. Epub 2019 Nov 5.
Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has dramatically increased in incidence and prevalence among patients aged 70 and older. There are virtually no data regarding outcomes in this population, and thus optimal therapy, including the role of chemotherapy for those undergoing radiotherapy (RT), remains unclear.
The National Cancer Database was queried for older adults (defined as age 70 years and older) with locally advanced OPSCC (cT1-2N1-3, cT3-4N0-3) diagnosed from 2010 to 2014 with known HPV-status undergoing definitive RT alone or chemoradiation (CRT).
Overall, 1,965 older adults with locally advanced OPSCC met inclusion criteria, including 1,141 HPV-positive (58%) and 824 HPV-negative (42%) patients. 1,211 patients (62%) received CRT. In multivariable analysis, CRT was associated with improved survival in older patients when compared to RT alone (hazard ratio [HR] = 0.74, 95% confidence interval [CI] 0.64-0.86, P < 0.001). CRT was associated with improved survival in both HPV-positive (HR = 0.80, 95% CI: 0.64-1.00, P = 0.05) and HPV-negative (HR = 0.69, 95% CI: 0.56-0.85, P < 0.001) subgroups. There was no significant interaction between HPV status and the impact of CRT on survival (P interaction = 0.57).
Despite the radiosensitivity of HPV-positive OPSCC and the challenges in delivering CRT to older adults, CRT was associated with improved survival in older patients with HPV-positive OPSCC, similar in magnitude to the benefit in HPV-negative patients. As the incidence of HPV-positive OPSCC in older patients continues to increase, further studies are needed to investigate optimal therapeutic strategies in this population.
人乳头瘤病毒（HPV）阳性口咽鳞状细胞癌（OPSCC）在 70 岁及以上患者中的发病率和患病率显著增加。针对该人群的治疗结果几乎没有相关数据，因此，最佳治疗方案，包括接受放疗（RT）的患者的化疗作用，尚不清楚。
从 2010 年至 2014 年，国家癌症数据库（National Cancer Database）对诊断为局部晚期 OPSCC（cT1-2N1-3，cT3-4N0-3）的年龄在 70 岁及以上的老年患者（定义为年龄≥70 岁）进行了检索，这些患者接受了单纯根治性 RT 或放化疗（CRT），已知 HPV 状态。
共有 1965 名患有局部晚期 OPSCC 的老年患者符合纳入标准，包括 1141 名 HPV 阳性（58%）和 824 名 HPV 阴性（42%）患者。1211 名患者（62%）接受了 CRT。多变量分析显示，与单纯 RT 相比，CRT 可改善老年患者的生存（风险比[HR] = 0.74，95%置信区间[CI] 0.64-0.86，P < 0.001）。CRT 改善了 HPV 阳性（HR = 0.80，95% CI：0.64-1.00，P = 0.05）和 HPV 阴性（HR = 0.69，95% CI：0.56-0.85，P < 0.001）亚组的生存。HPV 状态与 CRT 对生存的影响之间无显著交互作用（P 交互= 0.57）。
尽管 HPV 阳性 OPSCC 对放疗敏感，且为老年患者提供 CRT 存在挑战，但在 HPV 阳性 OPSCC 老年患者中，CRT 与生存改善相关，与 HPV 阴性患者的获益程度相当。随着 HPV 阳性 OPSCC 在老年患者中的发病率持续增加，需要进一步研究以探讨该人群的最佳治疗策略。
