Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, USA.
Department of Radiation Oncology, NYU School of Medicine, New York, New York, USA.
Otolaryngol Head Neck Surg. 2021 Jul;165(1):104-112. doi: 10.1177/0194599820973256. Epub 2020 Dec 8.
To investigate the patterns of care and outcomes of treatment of early stage tonsil cancers, controlling for human papillomavirus (HPV) status.
Historical cohort study.
National Cancer Database (NCDB).
Review of the NCDB between 2010 and 2017 for all T1-2N0M0 tonsillar squamous cell carcinoma (SCC). Demographics, clinical characteristics, HPV status, treatment regimens, and survival were analyzed.
A total of 4720 patients were identified with early stage SCC of the tonsil. Most were tested for HPV (2759 [58.5%]). Among tested patients, 1758 (63.7%) were positive for HPV and 1001 (36.3%) were negative for HPV. HPV-positive patients had higher 3-year survival compared to HPV-negative patients (93.2% vs 77.8%, < .001). Among HPV-positive patients, there was no significant difference in survival between treatment cohorts. However, in the HPV-negative cohort, 3-year survival was higher in both bimodality surgical-based settings (tonsillectomy + neck dissection + radiotherapy, 86.0% vs chemoradiotherapy, 69.6%, = .01) and for all surgical-based treatments when compared to nonsurgical management (84.6% vs 69.3%, < .001). This difference was maintained in multivariable regression controlling for age, sex, comorbidities, clinical T stage, and treatments. In a subpopulation of HPV-negative patients propensity score matched by all factors significant in multivariable analysis, 3-year survival remained higher in the surgically treated group compared to the nonsurgically treated cohort (84.9% vs 67.1%, < .001).
Surgical- or radiation-based treatment resulted in similar survival in early stage HPV-positive tonsil cancer. Surgical-based treatments were associated with longer survival in HPV-negative cancers. These findings should be further investigated in a randomized prospective trial.
通过控制人乳头瘤病毒（HPV）状态，研究早期扁桃体癌的治疗模式和疗效。
历史队列研究。
国家癌症数据库（NCDB）。
对 2010 年至 2017 年 NCDB 中所有 T1-2N0M0 扁桃体鳞状细胞癌（SCC）患者进行回顾性分析。分析患者的人口统计学、临床特征、HPV 状态、治疗方案和生存情况。
共纳入 4720 例早期扁桃体 SCC 患者。大多数患者接受了 HPV 检测（2759 例[58.5%]）。在接受检测的患者中，1758 例（63.7%）HPV 阳性，1001 例（36.3%）HPV 阴性。HPV 阳性患者的 3 年生存率高于 HPV 阴性患者（93.2%比 77.8%，<.001）。在 HPV 阳性患者中，不同治疗组之间的生存无显著差异。然而，在 HPV 阴性患者中，与放化疗相比，双模态手术治疗（扁桃体切除术+颈清扫术+放疗，86.0%比 69.6%，<.01）和所有手术治疗（84.6%比 69.3%，<.001）的 3 年生存率更高。在多变量回归中，在校正年龄、性别、合并症、临床 T 分期和治疗方法后，这种差异仍然存在。在多变量分析中所有有统计学意义的因素进行倾向评分匹配的 HPV 阴性患者亚组中，手术治疗组的 3 年生存率仍高于非手术治疗组（84.9%比 67.1%，<.001）。
在早期 HPV 阳性扁桃体癌中，手术或放疗的疗效相似。手术治疗与 HPV 阴性癌症的生存时间延长有关。这些发现需要在随机前瞻性试验中进一步研究。
