北美观测队列中 HPV 阳性鼻咽癌的临床表现和结局。

Clinical presentation and outcome of human papillomavirus-positive nasopharyngeal carcinoma in a North American cohort.

机构信息

Department of Radiation Oncology, Princess Margaret Cancer Center/University of Toronto, Toronto, Ontario, Canada.

Department of Otolaryngology-Head and Neck Surgery and Surgical Oncology, Princess Margaret Cancer Center/University of Toronto, Toronto, Ontario, Canada.

出版信息

Cancer. 2022 Aug 1;128(15):2908-2921. doi: 10.1002/cncr.34266. Epub 2022 May 19.

DOI:10.1002/cncr.34266

PMID:35588085

Abstract

BACKGROUND

The objective of this study was to describe the clinical presentation and outcomes of human papillomavirus (HPV)-positive nasopharyngeal cancer (NPC) versus Epstein-Barr virus (EBV)-positive NPC and HPV-positive oropharyngeal cancer (OPC).

METHODS

Clinical characteristics and presenting signs/symptoms were compared between patients who had viral-related NPC versus viral-related OPC treated with intensity-modulated radiotherapy from 2005 to 2020 and who were matched 1:1 (by tumor and lymph node categories, smoking, age, sex, histology, and year of diagnosis). Locoregional control (LRC), distant control (DC), and overall survival (OS) were compared using the 2005-2018 cohort to maintain 2 years of minimum follow-up. Multivariable analysis was used to evaluate the cohort effect.

RESULTS

Similar to HPV-positive OPC (n = 1531), HPV-positive NPC (n = 29) occurred mostly in White patients compared with EBV-positive NPC (n = 422; 86% vs. 15%; p < .001). Primary tumor volumes were larger in HPV-positive NPC versus EBV-positive NPC (median volume, 51 vs. 23 cm ; p = .002), with marginally more Level IB nodal involvement. More patients with HPV-positive NPC complained of local pain (38% vs. 3%; p = .002). The median follow-up for the 2005-2018 cohort was 5.3 years. Patients who had HPV-positive NPC (n = 20) had rates of 3-year LRC (95% vs. 90%; p = .360), DC (75% vs. 87%; p = .188), and OS (84% vs. 89%; p = .311) similar to the rates in those who had EBV-positive NPC (n = 374). Patients who had HPV-positive NPC also had rates of LRC (95% vs. 94%; p = .709) and OS (84% vs. 87%; p = .440) similar to the rates in those who had HPV-positive OPC (n = 1287). The DC rate was lower in patients who had HPV-positive disease (75% vs. 90%; p = .046), but the difference became nonsignificant (p = .220) when the analysis was adjusted for tumor and lymph node categories, smoking, and chemotherapy.

CONCLUSIONS

HPV-positive NPC and EBV-positive NPC seem to be mutually exclusive diseases. Patients who have HPV-positive NPC have greater local symptom burden and larger primary tumors but have similar outcomes compared with patients who have EBV-positive NPC or HPV-positive OPC.

摘要

背景

本研究旨在描述人乳头瘤病毒（HPV）阳性鼻咽癌（NPC）与 EBV 阳性 NPC 以及 HPV 阳性口咽癌（OPC）的临床表现和结局。

方法

对 2005 年至 2020 年接受调强放疗的病毒相关性 NPC 和 OPC 患者的临床特征和表现症状进行比较，这些患者按肿瘤和淋巴结分类、吸烟、年龄、性别、组织学和诊断年份进行 1:1 匹配。使用 2005-2018 年队列比较局部区域控制（LRC）、远处控制（DC）和总生存（OS），以保持至少 2 年的随访。使用多变量分析评估队列效应。

结果

与 HPV 阳性 OPC（n=1531）相似，HPV 阳性 NPC（n=29）主要发生在白人患者中，而 EBV 阳性 NPC（n=422；86% vs. 15%；p<.001）。HPV 阳性 NPC 的原发肿瘤体积大于 EBV 阳性 NPC（中位体积，51 vs. 23 cm；p=0.002），且更有可能出现 IB 级淋巴结受累。更多 HPV 阳性 NPC 患者主诉局部疼痛（38% vs. 3%；p=0.002）。2005-2018 年队列的中位随访时间为 5.3 年。HPV 阳性 NPC 患者（n=20）的 3 年 LRC（95% vs. 90%；p=0.360）、DC（75% vs. 87%；p=0.188）和 OS（84% vs. 89%；p=0.311）与 EBV 阳性 NPC 患者（n=374）相似。HPV 阳性 NPC 患者的 LRC（95% vs. 94%；p=0.709）和 OS（84% vs. 87%；p=0.440）与 HPV 阳性 OPC 患者（n=1287）相似。HPV 阳性疾病患者的 DC 率较低（75% vs. 90%；p=0.046），但在调整肿瘤和淋巴结分类、吸烟和化疗后，差异无统计学意义（p=0.220）。