Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada.
BMC Cancer. 2022 May 7;22(1):513. doi: 10.1186/s12885-022-09515-2.
The revised 8th Edition American Joint Committee on Cancer (AJCC) Head and Neck Staging Manual distinguishes HPV-mediated from non-HPV-mediated oropharyngeal cancer (OpSCC). The objective was to analyze OpSCC treatment modalities and outcomes.
A retrospective study of OpSCC patients treated with radiotherapy or chemoradiotherapy between January 1st, 2000, and December 31st, 2008, as identified from the BC Cancer Registry. All patients received treatment at cancer clinics and had at least 5 years follow-up post-treatment. A total of 1259 OpSCC patients were identified. After initial chart reviews, 288 patients were excluded from further analysis and the majority (n = 198) was due to not receiving curative treatment. Based on the availability of formalin-fixed, paraffin-embedded (FFPE) tissue, patients were divided into two cohorts: Study Cohort (FFPE available, n = 244) and General Cohort (FFPE unavailable, n = 727). The Study Cohort was restaged according to AJCC 8th Edition based on p16 immunohistochemistry status. Kaplan-Meier analysis was used to estimate the 5-year overall survival (OS), disease-specific survival (DSS), and locoregional recurrence-free survival (LFS).
Among 971 patients, OpSCC age-adjusted incidence rate was observed to have increased from 2.1 to 3.5 per 100,000 between 2000 and 2008. The General Cohort was relatively older than the Study Cohort (60.1 ± 10.5 vs. 57.3 ± 9.4), but both cohorts were predominantly males (78.3% vs. 76.2%). Amongst the Study Cohort, 77.5% were p16-positive, of whom 98.4% were down staged in the 8th Edition. These early-stage patients showed OS improvement for those treated with chemoradiation, compared to radiation alone (85.8% vs. 73.1%, p = 0.05).
OpSCC incidence is increasing in BC. The addition of chemotherapy to radiotherapy may portend a benefit in OS even for early-stage p16-positive OpSCC. Additional research is necessary to assess the safety of treatment de-escalation even among early-stage disease.
修订后的第 8 版美国癌症联合委员会（AJCC）头颈部分期手册区分了 HPV 介导的与非 HPV 介导的口咽癌（OpSCC）。目的是分析 OpSCC 的治疗方式和结果。
这是一项回顾性研究，纳入了 2000 年 1 月 1 日至 2008 年 12 月 31 日期间从不列颠哥伦比亚癌症登记处确定的接受放疗或放化疗治疗的 OpSCC 患者。所有患者均在癌症诊所接受治疗，且至少随访 5 年。共确定了 1259 例 OpSCC 患者。经过最初的病历审查，有 288 例患者被排除在进一步分析之外，其中大多数（n=198）是因为未接受根治性治疗。根据是否有福尔马林固定、石蜡包埋（FFPE）组织，患者被分为两个队列：研究队列（FFPE 可用，n=244）和一般队列（FFPE 不可用，n=727）。根据 p16 免疫组化状态，研究队列根据 AJCC 第 8 版进行重新分期。Kaplan-Meier 分析用于估计 5 年总生存率（OS）、疾病特异性生存率（DSS）和局部区域无复发生存率（LFS）。
在 971 例患者中，OpSCC 的年龄校正发病率在 2000 年至 2008 年间从每 10 万人 2.1 例增加到 3.5 例。一般队列的年龄大于研究队列（60.1±10.5 岁比 57.3±9.4 岁），但两个队列均以男性为主（78.3%比 76.2%）。在研究队列中，77.5%的患者 p16 阳性，其中 98.4%在第 8 版中降期。与单独放疗相比，接受放化疗的这些早期患者的 OS 有所改善（85.8%比 73.1%，p=0.05）。
不列颠哥伦比亚省 OpSCC 的发病率正在增加。在放疗的基础上加用化疗可能会改善 OS，即使是对于 p16 阳性的早期 OpSCC 患者。需要进一步研究来评估甚至在早期疾病中降低治疗强度的安全性。
