Harvard Medical School, Boston, Massachusetts.
Harvard Radiation Oncology Program, Boston, Massachusetts.
Cancer. 2020 Apr 1;126(7):1424-1433. doi: 10.1002/cncr.32652. Epub 2020 Jan 13.
There is substantial variation in head and neck cancer (HNC) mortality and competing mortality among patients with HNC. In this study, the authors characterize the causes and risks of short-term mortality among patients with oropharynx cancer (OPC) and how these risks differ by human papillomavirus (HPV) status.
A custom Surveillance, Epidemiology, and End Results (SEER) data set with HPV status was used to identify 4930 patients with OPC who were diagnosed with nonmetastatic (M0) disease from 2013 to 2014, including 3560 (72.2%) HPV-positive patients and 1370 HPV-negative patients. Causes of death and cumulative incidence estimates for HNC-specific mortality, competing mortality, second-cancer mortality, and noncancer mortality were analyzed by HPV status. Risk factors for mortality events were determined using multivariable competing risk regression models.
Compared with HPV-negative patients, HPV-positive patients had a lower risk of 2-year cumulative incidence of all-cause mortality (10.4% vs 33.3%; P < .0001) and a lower risk of both HNC-specific mortality (4.8% vs 16.2%; P < .0001) and competing-cause mortality (5.6% vs 16.8%; P < .0001). Second-cancer mortality was the most common cause of non-HNC mortality among HPV-negative patients. Both second-cancer mortality and noncancer mortality were significantly higher among patients who had HPV-negative OPC (10.8% and 6.1%, respectively) compared with those who had HPV-positive OPC (2.4% and 3.2%, respectively; both P < .0001). The median follow-up was 11 months (range 1-23 months) in this cohort with known HPV-status.
Patients with HPV-positive and HPV-negative OPC have significantly different rates of both HNC mortality and competing mortality. HPV-negative patients are at substantial risk of competing mortality, even within 2 years of cancer diagnosis. These differences can inform power calculations for clinical trials and patient management in the acute and survivorship settings.
头颈部癌症（HNC）的死亡率和 HNC 患者的竞争死亡率存在很大差异。在这项研究中，作者描述了口咽癌（OPC）患者短期死亡的原因和风险，以及这些风险如何因人乳头瘤病毒（HPV）状态而异。
使用定制的监测、流行病学和最终结果（SEER）数据集和 HPV 状态，确定了 4930 例 2013 年至 2014 年诊断为非转移性（M0）疾病的 OPC 患者，其中包括 3560 例（72.2%）HPV 阳性患者和 1370 例 HPV 阴性患者。按 HPV 状态分析 HNC 特异性死亡率、竞争死亡率、第二癌症死亡率和非癌症死亡率的死亡原因和累积发生率估计值。使用多变量竞争风险回归模型确定死亡事件的危险因素。
与 HPV 阴性患者相比，HPV 阳性患者 2 年全因死亡率的累积发生率较低（10.4%比 33.3%；P<0.0001），HNC 特异性死亡率（4.8%比 16.2%；P<0.0001）和竞争原因死亡率（5.6%比 16.8%；P<0.0001）的风险也较低。第二癌症死亡率是 HPV 阴性患者非 HNC 死亡的最常见原因。HPV 阴性 OPC 患者的第二癌症死亡率（10.8%）和非癌症死亡率（6.1%）均明显高于 HPV 阳性 OPC 患者（分别为 2.4%和 3.2%；均 P<0.0001）。该 HPV 状态队列的中位随访时间为 11 个月（范围为 1-23 个月）。
HPV 阳性和 HPV 阴性 OPC 患者的 HNC 死亡率和竞争死亡率存在显著差异。即使在癌症诊断后 2 年内，HPV 阴性患者也面临着巨大的竞争死亡率风险。这些差异可以为临床试验的效力计算和急性及生存环境中的患者管理提供信息。
