Kędzierawski Piotr, Huruk-Kuchinka Anna, Radowicz-Chil Agnieszka, Mężyk Ryszard, Rugała Zdzisława, Sadowski Jacek
Department of Radiotherapy, Holycross Cancer Centre, Kielce, Poland.
Department of Pathology, Holycross Cancer Centre, Kielce, Poland.
Arch Med Sci. 2020 Sep 23;17(5):1308-1316. doi: 10.5114/aoms.2019.83658. eCollection 2021.
Squamous cell carcinoma is the most common malignant tumour occurring in the head and neck region. It is now understood that (human papillomavirus (HPV)- positive and HPV-negative diseases are two very different clinical entities associated with different outcomes. We decided to assess p16 expression status in patients with oropharyngeal cancer and retrospectively evaluate the outcomes of the treatment.
The evaluated group consisted of 98 consecutive patients with squamous cell carcinoma of the oropharynx treated in a combined way in Holycross Cancer Centre in Kielce in 2006-2014. For all patients p16 status was assessed based on the biological material. In 51 patients HPV infection was diagnosed. The Kaplan-Meier method was used to produce survival curves using the log-rank test and the Cox proportional hazard model was used to determine the risk factors. The following risk factors were included: HPV status (positive, negative), sex, age, smoking, histopathological grade of the tumour, clinical stage, and systemic therapy application. For HPV-positive and HPV-negative patients independent analyses were done including aforementioned factors, excluding HPV status.
The observation time for HPV-positive patients was significantly longer ( = 0.0008). Fifty-eight patients died, 40 patients are alive. Number of deaths in HPV-negative patients was statistically significantly higher ( = 0.0222). A statistically significant difference in the disease-free survival probability and overall survival probability between HPV-positive and HPV-negative patients was found ( = 0.0045 and = 0.0037 respectively). For disease-free survival a statistically significant factor of the risk of recurrence was HPV infection ( = 0.0169). For HPV-positive patients, age ( = 0.0199) and smoking ( = 0.0353) were statistically significant risk factors of recurrence. For HPV-negative patients significant risk factors of recurrence were clinical stage ( = 0.0114) and systemic therapy application ( = 0.0271). For overall survival for the entire group statistically significant risk factors were absence of HPV infection ( = 0.0123), male sex ( = 0.0426), and age ( = 0.0311). For HPV-positive patients, age ( = 0.0096) and smoking ( = 0.0387) were statistically significant risk factors of death. For HPV-negative patients significant risk factors of death were clinical stage ( = 0.0120) and systemic therapy application ( = 0.0460).
Our data show that HPV infection is a predictor of better disease-free and overall survival in patients with oropharyngeal cancer. For HPV-positive oropharyngeal cancer patients weekly given cisplatin with concurrent radiotherapy can be an alternative to three weekly given cisplatin considering effectiveness and early toxicity.
鳞状细胞癌是头颈部最常见的恶性肿瘤。现在已经明确，（人乳头瘤病毒（HPV）阳性和HPV阴性疾病是两种截然不同的临床实体，其预后不同。我们决定评估口咽癌患者的p16表达状态，并回顾性评估治疗结果。
评估组由2006年至2014年在凯尔采的圣十字癌症中心接受联合治疗的98例连续性口咽鳞状细胞癌患者组成。对所有患者，根据生物材料评估p16状态。51例患者被诊断出HPV感染。采用Kaplan-Meier方法绘制生存曲线，使用对数秩检验，并用Cox比例风险模型确定危险因素。纳入以下危险因素：HPV状态（阳性、阴性）、性别、年龄、吸烟、肿瘤组织病理学分级、临床分期和全身治疗应用情况。对HPV阳性和HPV阴性患者分别进行独立分析，包括上述因素，但不包括HPV状态。
HPV阳性患者的观察时间显著更长（P = 0.0008）。58例患者死亡，40例患者存活。HPV阴性患者的死亡人数在统计学上显著更高（P = 0.0222）。发现HPV阳性和HPV阴性患者在无病生存概率和总生存概率上存在统计学显著差异（分别为P = 0.0045和P = 0.0037）。对于无病生存，HPV感染是复发风险的统计学显著因素（P = 0.0169）。对于HPV阳性患者，年龄（P = 0.0199）和吸烟（P = 0.0353）是复发的统计学显著危险因素。对于HPV阴性患者，复发的显著危险因素是临床分期（P = 0.0114）和全身治疗应用情况（P = 0.0271）。对于整个组的总生存，统计学显著危险因素是无HPV感染（P = 0.0123）、男性（P = 0.0426）和年龄（P = 0.0311）。对于HPV阳性患者，年龄（P = 0.0096）和吸烟（P = 0.0387）是死亡的统计学显著危险因素。对于HPV阴性患者，死亡的显著危险因素是临床分期（P = 0.0120）和全身治疗应用情况（P = 0.0460）。
我们的数据表明，HPV感染是口咽癌患者无病生存和总生存较好的预测指标。对于HPV阳性的口咽癌患者，考虑到有效性和早期毒性，每周给予顺铂同步放疗可作为每三周给予顺铂的替代方案。
