人乳头瘤病毒相关口咽癌延迟诊断后的疾病概况及肿瘤学结局

Disease Profile and Oncologic Outcomes After Delayed Diagnosis of Human Papillomavirus-Associated Oropharyngeal Cancer.

作者信息

Yin Linda X, Karp Emily E, Elias Anna, O'Byrne Thomas J, Routman David M, Price Daniel L, Kasperbauer Jan L, Neben-Wittich Michelle, Chintakuntlawar Ashish V, Price Katharine A, Ma Daniel J, Foote Robert L, Moore Eric J, Van Abel Kathryn M

机构信息

Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.

Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA.

出版信息

Otolaryngol Head Neck Surg. 2021 Dec;165(6):830-837. doi: 10.1177/01945998211000426. Epub 2021 Mar 23.

DOI:10.1177/01945998211000426

PMID:33752487

Abstract

OBJECTIVE

Diagnostic delay in human papillomavirus-associated oropharynx squamous cell carcinoma (HPV(+)OPSCC) is common due to nonspecific symptoms. We aim to describe the disease burden and oncologic outcomes of patients with HPV(+)OPSCC diagnosed >12 months after symptom onset.

STUDY DESIGN

This is a retrospective cohort study of HPV(+)OPSCC patients receiving intent-to-cure treatment (including surgery ± adjuvant therapy or primary chemoradiation).

SETTING

2006-2016, tertiary care center.

METHODS

Tumor stage was compared between patients with and without delayed diagnosis using χ tests. Kaplan-Meier survival analysis with univariate and multivariable Cox regressions were used to determine the effect of diagnostic delay on oncologic outcomes.

RESULTS

In total, 664 patients were included. Compared to patients diagnosed <12 months from symptom onset (n = 601), those diagnosed at >12 months (n = 63) were more likely to have T4 disease and higher overall American Joint Committee on Cancer (AJCC) clinical stage at presentation ( < .01 for both). At 5 years, rates of overall survival, cancer-specific survival, progression-free survival, and distant metastases-free survival in the delayed diagnosis cohort were 80%, 90%, 80%, and 89%, respectively. A >12-month delay in diagnosis did not significantly impact overall survival (adjusted hazard ratio [aHR], 1.16; 95% CI, 0.58-2.31), cancer-specific survival (aHR, 0.83; 95% CI, 0.29-2.39), progression-free survival (aHR, 1.15; 95% CI, 0.56-2.37), or distant metastases-free survival (aHR, 1.00; 95% CI, 0.42-2.40) after adjusting for age, sex, and clinical AJCC stage ( > .05 for all).

CONCLUSIONS

Delayed diagnosis of HPV(+)OPSCC is associated with greater burden of disease at presentation, but oncologic outcomes remain favorable across treatment modalities. When appropriate, intent-to-cure therapy should be pursued despite diagnostic delay.

LEVEL OF EVIDENCE

Level III.

摘要

目的

由于症状不具特异性，人乳头瘤病毒相关口咽鳞状细胞癌（HPV(+)OPSCC）的诊断延迟很常见。我们旨在描述症状出现12个月后确诊的HPV(+)OPSCC患者的疾病负担和肿瘤学结局。

研究设计

这是一项对接受根治性治疗（包括手术±辅助治疗或原发放化疗）的HPV(+)OPSCC患者的回顾性队列研究。

研究地点

2006 - 2016年，三级医疗中心。

方法

使用χ检验比较延迟诊断和未延迟诊断患者的肿瘤分期。采用Kaplan-Meier生存分析以及单变量和多变量Cox回归来确定诊断延迟对肿瘤学结局的影响。

结果

共纳入664例患者。与症状出现后12个月内确诊的患者（n = 601）相比，12个月后确诊的患者（n = 63）更有可能出现T4期疾病，且就诊时美国癌症联合委员会（AJCC）临床分期更高（两者均P <.01）。5年时，延迟诊断队列的总生存率、癌症特异性生存率、无进展生存率和无远处转移生存率分别为80%、90%、80%和89%。在调整年龄、性别和临床AJCC分期后，诊断延迟超过12个月对总生存率（调整后风险比[aHR]，1.16；95%置信区间[CI]，0.58 - 2.31）、癌症特异性生存率（aHR，0.83；95% CI，0.29 - 2.39）、无进展生存率（aHR，1.15；95% CI，0.56 - 2.37）或无远处转移生存率（aHR，1.00；95% CI，0.42 - 2.40）均无显著影响（所有P >.05）。