内科合并症在手术治疗的人乳头瘤病毒相关口咽鳞状细胞癌中的预后作用。
The prognostic role of medical comorbidities in surgically treated human papillomavirus-associated oropharyngeal squamous cell carcinoma.
作者信息
Yin Linda X, Puccinelli Cassandra L, Price Daniel L, Karp Emily E, Price Katharine A, Ma Dan J, Lohse Christine, Moore Eric J, Abel Kathryn M Van
机构信息
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA.
出版信息
Oral Oncol. 2020 Sep;108:104822. doi: 10.1016/j.oraloncology.2020.104822. Epub 2020 Jun 3.
OBJECTIVE
Prognostic factors specific to surgically managed human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC) are not fully understood. Medical co-morbidities may have an impact on survival after surgical treatment. We aimed to identify co-morbidities associated with distant metastases-free survival (DMFS) and cancer-specific survival (CSS) in HPV(+)OPSCCs.
METHODS
This is a retrospective case series of HPV(+)OPSCC patients at a tertiary referral center from 2007 to 2016. All patients in the study underwent primary intent-to-cure transoral resection with concomitant neck dissection ± adjuvant radiation ± chemotherapy. Exclusion criteria included a history of previous head and neck cancer or distant metastases at diagnosis. Associations with DMFS and CSS were evaluated using univariable and multivariable Cox regression and summarized with hazard ratios (HRs).
RESULTS
406 patients were included in the cohort (100% HPV(+), 90% Male). All had tumors of the tonsil (62%) or base of tongue (38%). Median follow-up for the cohort was 4.0 years (IQR: 2.6-6.2). Higher tumor stage and a higher Adult Comorbidity Evaluation-27 score were significantly associated with worse DMFS and CSS (p < 0.02 for all). A history of diabetes mellitus (N = 36, 9%) was significantly associated with DMFS (HR 3.05 [95%CI 1.26-7.37], p = 0.014) and CSS (HR 4.82 [95%CI 1.84-12.61], p = 0.001). On multivariable analysis, after adjusting for tumor stage, diabetes remained significantly associated with worse DMFS (HR 2.58 [95%CI 1.06-6.26], p = 0.037).
CONCLUSION
Diabetes mellitus may be associated with worse DMFS and CSS in surgically managed HPV(+)OPSCC.
目的
对于手术治疗的人乳头瘤病毒（HPV）相关口咽鳞状细胞癌（HPV(+)OPSCC），其特定的预后因素尚未完全明确。合并症可能会对手术治疗后的生存产生影响。我们旨在确定与HPV(+)OPSCC患者无远处转移生存期（DMFS）和癌症特异性生存期（CSS）相关的合并症。
方法
这是一项对2007年至2016年在一家三级转诊中心的HPV(+)OPSCC患者进行的回顾性病例系列研究。研究中的所有患者均接受了根治性经口切除术并同期行颈部淋巴结清扫术±辅助放疗±化疗。排除标准包括既往有头颈癌病史或诊断时已有远处转移。使用单变量和多变量Cox回归评估与DMFS和CSS的相关性，并以风险比（HR）进行总结。
结果
该队列纳入了406例患者（100%为HPV阳性，90%为男性）。所有患者的肿瘤均位于扁桃体（62%）或舌根（38%）。该队列的中位随访时间为4.0年（四分位间距：2.6 - 6.2年）。较高的肿瘤分期和较高的成人合并症评估-27评分与较差的DMFS和CSS显著相关（所有p值均<0.02）。糖尿病病史（n = 36，9%）与DMFS（HR 3.05 [95%CI 1.26 - 7.37]，p = 0.014）和CSS（HR 4.82 [95%CI 1.84 - 12.61]，p = 0.001）显著相关。在多变量分析中，在调整肿瘤分期后，糖尿病仍与较差的DMFS显著相关（HR 2.58 [95%CI 1.06 - 6.26]，p = 0.037）。
结论
在接受手术治疗的HPV(+)OPSCC患者中，糖尿病可能与较差的DMFS和CSS相关。
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