吸烟和原发肿瘤部位对 HPV 相关口咽鳞状细胞癌复发的影响。

Impact of Smoking and Primary Tumor Subsite on Recurrence in HPV-Associated Oropharyngeal Squamous Cell Carcinoma.

机构信息

School of Medicine, University of California San Francisco, San Francisco, California, USA.

Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA.

出版信息

Otolaryngol Head Neck Surg. 2022 Apr;166(4):704-711. doi: 10.1177/01945998211024515. Epub 2021 Jun 29.

DOI:10.1177/01945998211024515

PMID:34182836

Abstract

OBJECTIVE

To describe risk of recurrence and recurrence characteristics between ever- and never-smoking patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC) when stratified by primary tumor subsite.

STUDY DESIGN

Retrospective observational study.

SETTING

Tertiary care center.

METHODS

Retrospective chart review of 171 patients with HPV+ OPSCC with primary treatment between 2008 and 2019. Five-year recurrence-free survival and risk of recurrence were evaluated through Kaplan-Meier curves with log-rank test and Cox proportional hazards models, respectively.

RESULTS

Of 171 patients with HPV+ OPSCC, 81.9% were male, and the average age was 63.9 years. Eighty patients (46.8%) had a smoking history (average, 17.7 pack-years), including 4 current smokers. Recurrence occurred in 31 patients (18.1%), 19 of whom were ever smokers. The recurrence rate for ever smokers with primary base of tongue (BOT) cancer was 41.7%, while 5.1% of never smokers with BOT primaries had recurrence. For primary tonsillar disease, 9.1% of ever smokers had recurrence versus 19.2% of never smokers. Five-year recurrence-free survival for BOT primaries was lower in ever smokers than never smokers ( = .001) but did not differ between ever and never smokers for tonsillar primaries ( = .215). In multivariable analysis across this period, ever-smoking status was associated with higher risk of recurrence than never-smoking status in BOT primaries (adjusted hazard ratio, 7.36; 95% CI, 1.61-33.68; = .010) but with lower risk of recurrence after tonsillar primaries (adjusted hazard ratio, 0.23; 95% CI, 0.06-0.89; = .033).

CONCLUSION

Smoking may uniquely interact with tumor subsites within the oropharynx to influence recurrence risk. Understanding the association between smoking and HPV+ OPSCC recurrence could lead to personalized, evidence-based treatments to improve oncologic outcomes.

摘要

目的

描述 HPV 相关口咽鳞状细胞癌（HPV+ OPSCC）患者中，按原发肿瘤部位分层的吸烟与从不吸烟患者的复发风险和复发特征。

研究设计

回顾性观察性研究。

设置

三级护理中心。

方法

回顾性分析了 2008 年至 2019 年期间接受原发性治疗的 171 例 HPV+ OPSCC 患者的病历。通过 Kaplan-Meier 曲线和对数秩检验评估 5 年无复发生存率和复发风险，分别采用 Cox 比例风险模型。

结果

在 171 例 HPV+ OPSCC 患者中，81.9%为男性，平均年龄为 63.9 岁。80 例（46.8%）有吸烟史（平均，17.7 包年），其中 4 例为现吸烟者。31 例（18.1%）患者发生复发，其中 19 例为既往吸烟者。原发舌根（BOT）癌的吸烟患者复发率为 41.7%，而原发 BOT 的不吸烟患者复发率为 5.1%。对于原发性扁桃体疾病，吸烟患者的复发率为 9.1%，而不吸烟患者的复发率为 19.2%。BOT 原发性疾病患者的 5 年无复发生存率在吸烟患者中低于不吸烟患者（ =.001），但在扁桃体原发性疾病患者中，吸烟和不吸烟患者之间无差异（ =.215）。在此期间的多变量分析中，与从不吸烟状态相比，吸烟状态与 BOT 原发性疾病的复发风险更高（调整后的危险比，7.36；95%置信区间，1.61-33.68； =.010），但与扁桃体原发性疾病后的复发风险较低（调整后的危险比，0.23；95%置信区间，0.06-0.89； =.033）。