University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States.
Massachusetts Eye and Ear, Boston, MA, United States.
Oral Oncol. 2020 Jan;100:104475. doi: 10.1016/j.oraloncology.2019.104475. Epub 2019 Nov 22.
HPV mediated head and neck squamous cell carcinoma (HPVmHNSCC) is increasing in prevalence in the United States, as are reports of patients with multiple HPVmHNSCCs. The prevalence, demographics, and treatment implications of this emerging clinical entity are poorly understood.
We performed a multitiered assessment of patients with multiple HPVmHNSCC including: 1. systematic review of the literature, 2. query of the 2017 Surveillance, Epidemiology and End Results (SEER) database and 3. institutional level reporting at two high volume academic centers.
Systematic literature review: 13 articles met inclusion criteria (48 patients with multiple HPVmHNSCC). Pooled prevalence rate of multiple HPVmHNSCC was 2.64%. SEER database: 60(0.95%) patients with HPVmHNSCC had two tumors. Patients with multiple HPVmHNSCC were more likely to be younger and present with a lower T and N stage (p < 0.025 for all). The second identified tumor was more likely to be contralateral, found synchronously, of smaller size, and to occur in the tonsil (p < 0.05 for all). Institutional reporting: 17(1.69%) patients with HPVmHNSCC had two primary tumors. Similar to the SEER database, patients with multiple HPVmHNSCC were more likely to present with a low T stage and tonsil location (p < 0.007 for both).
Multiple HPVmHNSCCs occur in a subset of HPVmHNSCC cases with distinct characteristics. Thorough interrogation of all oropharyngeal subsites should be performed as part of the initial workup for HPVmHNSCC, with consideration given to contralateral tonsillectomy at the time of surgical resection for HPV mediated tonsil cancers due to the prevalence of contralateral tonsil primaries.
人乳头瘤病毒（HPV）介导的头颈部鳞状细胞癌（HPVmHNSCC）在美国的发病率不断上升，同时也有越来越多的患者患有多种 HPVmHNSCC 的报道。这种新兴临床实体的流行率、人口统计学特征和治疗意义尚不清楚。
我们对多种 HPVmHNSCC 患者进行了多层次评估，包括：1. 对文献进行系统回顾，2. 查询 2017 年监测、流行病学和最终结果（SEER）数据库，3. 在两个高容量学术中心进行机构层面报告。
系统文献回顾：13 篇文章符合纳入标准（48 例多种 HPVmHNSCC 患者）。多种 HPVmHNSCC 的总体患病率为 2.64%。SEER 数据库：60 例（0.95%）HPVmHNSCC 患者有两个肿瘤。患有多种 HPVmHNSCC 的患者更年轻，且 T 期和 N 期较低（所有 P 值均<0.025）。第二个确定的肿瘤更可能是对侧的，同步发现，体积较小，且发生在扁桃体（所有 P 值均<0.05）。机构报告：17 例（1.69%）HPVmHNSCC 患者有两个原发性肿瘤。与 SEER 数据库相似，患有多种 HPVmHNSCC 的患者更有可能表现为 T 期较低和扁桃体位置（两者 P 值均<0.007）。
多种 HPVmHNSCC 发生在 HPVmHNSCC 病例的一个亚组中，具有独特的特征。在初始 HPVmHNSCC 检查中，应彻底检查所有口咽亚部位，并考虑在因 HPV 介导的扁桃体癌进行手术切除时行对侧扁桃体切除术，因为对侧扁桃体原发性肿瘤的患病率较高。
