Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria.
Cancer Cluster Salzburg, 5020 Salzburg, Austria.
Int J Mol Sci. 2021 May 7;22(9):4981. doi: 10.3390/ijms22094981.
Head and neck squamous cell carcinoma (HNSCC) is a heterogeneous disease arising from the mucosa of the upper aerodigestive tract. Despite multimodality treatments approximately half of all patients with locally advanced disease relapse and the prognosis of patients with recurrent or metastatic HNSCC is dismal. The introduction of checkpoint inhibitors improved the treatment options for these patients and pembrolizumab alone or in combination with a platinum and fluorouracil is now the standard of care for first-line therapy. However, approximately only one third of unselected patients respond to this combination and the response rate to checkpoint inhibitors alone is even lower. This shows that there is an urgent need to improve prognostication and prediction of treatment benefits in patients with HNSCC. In this review, we summarize the most relevant risk factors in the field and discuss their roles and limitations. The human papilloma virus (HPV) status for patients with oropharyngeal cancer and the combined positive score are the only biomarkers consistently used in clinical routine. Other factors, such as the tumor mutational burden and the immune microenvironment have been highly studied and are promising but need validation in prospective trials.
头颈部鳞状细胞癌（HNSCC）是一种源于上呼吸道黏膜的异质性疾病。尽管采用了多模式治疗，但约一半局部晚期患者会复发，而复发性或转移性 HNSCC 患者的预后较差。检查点抑制剂的引入改善了这些患者的治疗选择，单独使用 pembrolizumab 或联合铂类和氟尿嘧啶现已成为一线治疗的标准。然而，大约只有三分之一的未选择患者对该联合治疗有反应，而单独使用检查点抑制剂的反应率甚至更低。这表明迫切需要改善 HNSCC 患者的预后和预测治疗效果。在这篇综述中，我们总结了该领域中最相关的风险因素，并讨论了它们的作用和局限性。HPV 状态对于口咽癌患者和联合阳性评分是唯一在临床常规中使用的生物标志物。其他因素，如肿瘤突变负担和免疫微环境已得到广泛研究，具有很大的前景，但需要在前瞻性试验中进行验证。
