Jordan Kelsey H, Fisher James L, Paskett Electra D
Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States.
Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States.
Front Oncol. 2022 Aug 18;12:980900. doi: 10.3389/fonc.2022.980900. eCollection 2022.
Oral cavity and pharynx cancer (OCPC) cases are traditionally dichotomized into human papillomavirus (HPV) and non-HPV types. Using a proxy for HPV status, the objective was to evaluate differences in incidence and survival rates of OCPC anatomic sub-sites identified as: 1) HPV-like; 2) non-HPV-like (i.e., tobacco/alcohol-related); and 3) "other"-like (i.e., not predominantly HPV-like nor tobacco/alcohol-like) OCPCs.
Data from the Surveillance, Epidemiology and End Results Program were used to examine incidence and survival rates for OCPC categories over time and according to age, sex, race, ethnicity, stage at diagnosis, neighborhood socioeconomic status (i.e., nSES or Yost Index), and rurality/urbanity (i.e., Rural Urban Commuting Area (RUCA) codes). Although HPV status was unavailable in this dataset, OCPC anatomies and histologies were classified into three sub-categories, based on potential risk factors. Frequencies, average annual, age-adjusted incidence rates, five-year relative survival rates, and 95% confidence intervals were examined across and within OCPC categories.
HPV-like OCPC incidence rates sharply increased from 1975 through 2015 while non-HPV-like and "other"-like OCPC rates decreased, all converging to similar rates from 2016 through 2018. Increasing over time for both categories, survival was highest for HPV-like and lowest for non-HPV-like OCPCs; survival for "other"-like OCPCs remained stable. Generally, across OCPC categories, incidence and survival rates were significantly higher among males vs. females, Whites vs. African Americans, and non-Hispanics vs. Hispanics. "Other"-like OCPC incidence decreased with increasing nSES tertiles, while no nSES differences were observed for HPV-like and non-HPV-like OCPCs. Incidence rates were significantly lower among urban (vs. rural) residents. For all OCPC categories, survival rates were significantly higher with increasing nSES and variable across RUCA categories.
CONCLUSION/IMPACT: HPV-like and non-HPV-like OCPC cases had distinct sociodemographic differences; "other"-like OCPC cases were a sociodemographic blend of HPV-like and non-HPV-like OCPC cases, resembling more of the sociodemographic makeup of non-HPV-like OCPC cases. To prevent new OCPCs, additional studies are needed to epidemiologically and clinically differentiate between OCPC categories so that high-risk groups can be better targeted in future public health interventions.
口腔和咽癌（OCPC）病例传统上分为人乳头瘤病毒（HPV）型和非HPV型。本研究使用一种HPV状态的替代指标，旨在评估被确定为以下三种类型的OCPC解剖亚部位在发病率和生存率上的差异：1）HPV样；2）非HPV样（即与烟草/酒精相关）；3）“其他”样（即既非主要HPV样也非烟草/酒精样）OCPC。
利用监测、流行病学和最终结果计划的数据，来研究不同时间段以及根据年龄、性别、种族、民族、诊断时的分期、邻里社会经济地位（即nSES或约斯特指数）和城乡属性（即农村城市通勤区（RUCA）代码）的OCPC类别的发病率和生存率。尽管该数据集中没有HPV状态信息，但根据潜在风险因素，将OCPC的解剖结构和组织学分为三个亚类别。对OCPC类别之间和内部的频率、年均年龄调整发病率、五年相对生存率以及95%置信区间进行了研究。
从1975年到2015年，HPV样OCPC的发病率急剧上升，而非HPV样和“其他”样OCPC的发病率下降，从2016年到2018年，所有类型的发病率趋于相似。两类OCPC的生存率均随时间增加，其中HPV样OCPC的生存率最高，非HPV样OCPC的生存率最低；“其他”样OCPC的生存率保持稳定。总体而言，在所有OCPC类别中，男性、白种人、非西班牙裔的发病率和生存率显著高于女性、非裔美国人、西班牙裔。“其他”样OCPC的发病率随nSES三分位数的增加而降低，而HPV样和非HPV样OCPC未观察到nSES差异。城市（相对于农村）居民的发病率显著较低。对于所有OCPC类别，生存率随nSES的增加而显著提高，且在RUCA类别中存在差异。
结论/影响：HPV样和非HPV样OCPC病例存在明显的社会人口统计学差异；“其他”样OCPC病例是HPV样和非HPV样OCPC病例的社会人口统计学混合体，更类似于非HPV样OCPC病例的社会人口统计学构成。为预防新的OCPC病例，需要进一步开展研究，从流行病学和临床角度区分OCPC类别，以便在未来的公共卫生干预中更好地针对高危人群。
