Chua Branden Qi Yu, Chong Vanessa Wei Shan, Kadir Hanis Binte Abdul, Yeo Brian Sheng Yep, Fong Pei Yuan, Jang Isabelle Jia Hui, Lim Chwee Ming
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Health Services Research Unit, Singapore General Hospital, Singapore, Singapore.
Ann Surg Oncol. 2025 Feb;32(2):1280-1300. doi: 10.1245/s10434-024-16362-x. Epub 2024 Nov 2.
Human papilloma virus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is rising in prevalence and is associated with better survival than HPV-negative OPSCC. In surgically treated HPV-negative OPSCCs, adverse pathologic features such as positive surgical margins, extra-nodal extension (ENE) and perineural invasion are well described to portend worse clinical outcomes. These adverse pathological features, however, are not validated prognostic markers among surgically treated HPV-positive OPSCCs. To that end, we pooled all available evidence to address the prognostic significance of these histologic features.
This meta-analysis was performed according to PRISMA guidelines. PubMed, Web of Science and Embase databases were systematically searched for articles evaluating 13 known adverse histopathological prognostic factors of surgically treated HPV-associated OPSCC. Data analysis was done using R v4.0.5.
A total of 32 studies (n = 31,535) fulfilled the inclusion criteria. ENE and advanced pT stage were associated with poorer overall survival (OS) [hazard ratio (HR):1.80, 95% confidence interval (CI) [1.59-2.03], p < 0.0001, HR: 3.28, 95% CI [2.20-4.87], p = 0.0025]; disease-specific survival (DSS) (HR: 3.14, 95% CI [1.20-8.26], p = 0.0327, HR: 3.49, 95% CI [2.45-4.96], p = 0.0043) and disease-free survival (DFS) (HR: 2.03, 95% CI [1.05-3.94], p = 0.0397, HR: 3.66, 95% CI [2.81-4.77], p = 0.0001) respectively. The presence of lymphovascular invasion (HR: 1.46, 95% CI [1.22-1.75], p = 0.0018) and positive margins (HR: 1.50, 95% CI [1.185-1.899], p = 0.0069) significantly worsen OS.
ENE, advanced pT stage, positive margins and lymphovascular invasion were adverse histologic prognostic marker among surgically treated HPV-positive OPSCC. The presence of these factors should be carefully evaluated in order to select the optimal patients for surgical treatment.
人乳头瘤病毒（HPV）阳性的口咽鳞状细胞癌（OPSCC）患病率呈上升趋势，且与比HPV阴性的OPSCC更好的生存率相关。在接受手术治疗的HPV阴性OPSCC中，不良病理特征如手术切缘阳性、结外扩展（ENE）和神经周围浸润，已被充分描述为预示更差的临床结局。然而，在接受手术治疗的HPV阳性OPSCC中，这些不良病理特征并非经过验证的预后标志物。为此，我们汇总了所有可用证据，以探讨这些组织学特征的预后意义。
本荟萃分析按照PRISMA指南进行。系统检索了PubMed、科学网和Embase数据库，以查找评估手术治疗的HPV相关OPSCC的13个已知不良组织病理学预后因素的文章。使用R v4.0.5进行数据分析。
共有32项研究（n = 31,535）符合纳入标准。ENE和pT分期晚期分别与较差的总生存期（OS）[风险比（HR）：1.80，95%置信区间（CI）[1.59 - 2.03]，p < 0.0001，HR：3.28，95%CI[2.20 - 4.87]，p = 0.0025]、疾病特异性生存期（DSS）（HR：3.14，95%CI[1.20 - 8.26]，p = 0.0327，HR：3.49，95%CI[2.45 - 4.96]，p = 0.0043）和无病生存期（DFS）（HR：2.03，95%CI[1.05 - 3.94]，p = 0.0397，HR：3.66，95%CI[2.81 - 4.77]，p = 0.0001）相关。存在脉管浸润（HR：1.46，95%CI[1.22 - 1.75]，p = 0.0018）和切缘阳性（HR：1.50，95%CI[1.185 - 1.899]，p = 0.0069）会显著恶化OS。
ENE、pT分期晚期、切缘阳性和脉管浸润是手术治疗的HPV阳性OPSCC的不良组织学预后标志物。应仔细评估这些因素的存在情况，以便为手术治疗选择最佳患者。
