Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
Cancer. 2021 Jun 15;127(12):2099-2110. doi: 10.1002/cncr.33440. Epub 2021 Feb 23.
Sexual behavior is associated with human papillomavirus (HPV)-positive head and neck cancer, whereas tobacco and alcohol use are associated with HPV-negative cancer. A case-control study was designed to investigate additional demographic and behavioral factors independently associated with these distinct oral cancers.
From 2011 to 2014, 249 newly diagnosed oral cavity and oropharyngeal squamous cell carcinoma (OSCC) cases were matched (1:2) on age, gender, and self-identified race to 498 controls without a cancer history attending the outpatient otolaryngology clinic at The Ohio State University in Columbus. Cases were stratified by detection of high-risk HPV DNA and RNA in tumors. Demographic and behavioral data were collected using an audio computer-assisted self-interview, and associations with HPV-positive versus HPV-negative OSCCs were investigated by use of univariable and multivariable conditional logistic regression models.
After adjustment for oral sexual behavior, the odds of HPV-positive cancer decreased with the patient's years of education. Annual income, tobacco smoking, alcohol drinking, marijuana smoking, and poor oral hygiene were not associated with HPV-positive OSCC. In contrast, the odds of HPV-negative OSCC increased independently with decreased annual income, decreased with a high number of marijuana hit-years, and increased with fewer than annual dental visits after adjustment for lifetime tobacco and alcohol use. Sexual behavior and education were not associated with HPV-negative OSCC.
The distinct risk-factor profiles for HPV-positive and HPV-negative OSCC are confirmed and extended in this case-control study, thus supporting 2 principal etiological pathways for OSCC development.
Sexually acquired human papillomavirus (HPV) infection is an established cause of tonsil and base of tongue cancers. This study compared and contrasted risk factors for HPV-positive and HPV-negative oral cancers. Low number of years of education and sexual behavior are associated with HPV-positive cancer. In contrast, low annual income, infrequent dental visits, and tobacco and alcohol use are associated with HPV-negative cancers. Long-term marijuana use appears protective for HPV-negative cancer. Public health efforts to address these modifiable risk factors may prevent oral cancer.
性行为与 HPV 阳性的头颈部癌症有关，而烟草和酒精的使用与 HPV 阴性癌症有关。本病例对照研究旨在调查与这些不同的口腔癌相关的其他人口统计学和行为因素。
2011 年至 2014 年，在哥伦布市俄亥俄州立大学门诊耳鼻喉科就诊的 249 名新诊断为口腔和口咽鳞状细胞癌（OSCC）的病例，根据年龄、性别和自我认定的种族与 498 名无癌症史的对照进行了 1:2 匹配。病例根据肿瘤中是否检测到高危 HPV DNA 和 RNA 进行分层。使用音频计算机辅助自我访谈收集人口统计学和行为数据，并使用单变量和多变量条件逻辑回归模型调查 HPV 阳性与 HPV 阴性 OSCC 之间的关联。
在调整了口腔性行为后，HPV 阳性癌症的发病几率随着患者受教育年限的增加而降低。年收入、吸烟、饮酒、吸食大麻和口腔卫生不良与 HPV 阳性 OSCC 无关。相比之下，HPV 阴性 OSCC 的发病几率随着年收入的减少而独立增加，随着大麻吸食年数的增加而减少，并且在调整终生吸烟和饮酒后，随着每年看牙医次数的减少而增加。性行为和教育与 HPV 阴性 OSCC 无关。
本病例对照研究证实并扩展了 HPV 阳性和 HPV 阴性 OSCC 的不同危险因素谱，从而支持 OSCC 发展的 2 个主要病因途径。
性传播的人乳头瘤病毒（HPV）感染是扁桃体和舌根癌的既定病因。本研究比较和对比了 HPV 阳性和 HPV 阴性口腔癌的危险因素。受教育年限少和性行为与 HPV 阳性癌症有关。相比之下，低收入、看牙医频率低以及吸烟和饮酒与 HPV 阴性癌症有关。长期吸食大麻似乎对 HPV 阴性癌症有保护作用。为解决这些可改变的危险因素而开展的公共卫生工作可能会预防口腔癌。
