Emory School of Medicine, Atlanta, GA.
Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, GA.
JCO Oncol Pract. 2020 Jun;16(6):e476-e487. doi: 10.1200/JOP.19.00400. Epub 2020 Jan 27.
Human papillomavirus (HPV)-related squamous cell carcinomas of the head and neck (SCCHNs) tend to have a distinct prognosis. Socioeconomic and demographic factors associated with metastatic disease at presentation and diagnosis in patients with HPV-related SCCHN tumors were examined.
The National Cancer Database (NCDB) was queried to assess patients with HPV-related oropharyngeal carcinomas (HPVOPCAs) and HPV-related nonoropharyngeal carcinomas (HPVNOPCAs) diagnosed between 2010 and 2014. Rate of metastases at presentation was analyzed using clinical M stage. Multivariable analysis was performed evaluating race, ethnicity, sex, age, facility location, facility type, insurance status, income, education, and tumor and nodal stage using logistic regression.
A total of 12,857 patients with HPVOPCA and 952 patients with HPVNOPCA were included. Private insurance was carried by 64% and 47% of patients with HPVOPCA and HPVNOPCA, respectively. HPVOPCA was located in the tonsil in 56% of patients. For both HPVOPCA and HPVNOPCA, there was no meaningful difference in distant metastasis at presentation based on facility type or location, sex, race, Hispanic ethnicity, or urban or rural location. For HPVOPCA, there were significantly lower odds of metastasis in privately insured patients compared with uninsured patients (odds ratio [OR], 0.37; 95% CI, 0.21 to 0.64; < .001) and higher odds of metastasis for patients living in census tracts with the lowest rates of high school graduates compared with the highest rates (OR, 1.81; 95% CI, 1.02 to 3.19; = .041) and for patients with higher tumor stage (OR, 3.67, 95% CI, 2.25 to 5.99; < .001) and nodal stage (OR, 3.34; 95% CI, 2.11 to 5.29; < .001). For HPVNOPCA, neither higher T or N stage nor any demographic features were found to be associated with metastasis at presentation.
This large retrospective analysis identifies likely modifiable risk factors for metastatic presentation in HPVOPCA. Educational interventions may result in modifications of these patterns.
人乳头瘤病毒（HPV）相关的头颈部鳞状细胞癌（SCCHN）的预后有明显的特征。本研究分析了与 HPV 相关的 SCCHN 肿瘤患者在初诊时出现转移性疾病相关的社会经济和人口统计学因素。
通过查询国家癌症数据库（NCDB）评估了 2010 年至 2014 年间诊断为 HPV 相关性口咽癌（HPVOPCA）和 HPV 相关性非口咽癌（HPVNOPCA）的患者。使用临床 M 分期分析初诊时转移率。采用 logistic 回归对种族、族裔、性别、年龄、机构位置、机构类型、保险状况、收入、教育程度以及肿瘤和淋巴结分期进行多变量分析。
共纳入 12857 例 HPVOPCA 患者和 952 例 HPVNOPCA 患者。HPVOPCA 患者中分别有 64%和 47%的患者拥有私人保险。HPVOPCA 患者中 56%肿瘤位于扁桃体。对于 HPVOPCA 和 HPVNOPCA，无论机构类型或位置、性别、种族、西班牙裔、城市或农村地区，初诊时远处转移无明显差异。与未参保患者相比，有私人保险的 HPVOPCA 患者转移的几率明显较低（比值比 [OR]，0.37；95%置信区间 [CI]，0.21 至 0.64；<0.001），而居住在高中毕业率最低的普查区的患者转移的几率较高（OR，1.81；95%CI，1.02 至 3.19；=0.041），肿瘤分期更高（OR，3.67；95%CI，2.25 至 5.99；<0.001），淋巴结分期更高（OR，3.34；95%CI，2.11 至 5.29；<0.001）。对于 HPVNOPCA，无论 T 或 N 分期更高，还是任何人口统计学特征，都与初诊时的转移无关。
本大规模回顾性分析确定了 HPVOPCA 患者出现转移性初诊的可能可改变的危险因素。教育干预可能会改变这些模式。
