血液或骨髓移植后与人乳头瘤病毒相关的鳞状细胞癌——一份血液或骨髓移植幸存者研究报告。
Human papillomavirus-related squamous cell carcinomas after blood or marrow transplantation-a Blood or Marrow Transplant Survivor Study report.
作者信息
Holmqvist Anna Sällfors, Meng Qingrui, Landier Wendy, Hageman Lindsey, Francisco Liton F, Ross Elizabeth Schlichting, Balas Nora, Bosworth Alysia, Te Hok Sreng, Bhatia Ravi, Wong F Lennie, Weisdorf Daniel, Armenian Saro H, Bhatia Smita
机构信息
Department of Clinical Sciences, Lund University, Childhood Cancer Center, Skåne University Hospital, Lund, Sweden.
Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham School of Medicine, Birmingham, AL 35233, United States.
出版信息
J Natl Cancer Inst. 2025 Jun 1;117(6):1166-1174. doi: 10.1093/jnci/djaf021.
BACKGROUND
Human papillomavirus (HPV) is associated with an increased risk for a variety of squamous cell carcinomas in the general population. The risk for subsequent squamous cell carcinomas in blood or marrow transplantation survivors that are potentially related to HPV (cervical, oropharyngeal, vulvar, vaginal, anal, and penile cancer; HPV-related squamous cell carcinomas) remains unknown.
METHODS
We determined the risk of HPV-related squamous cell carcinomas in 7936 2-year survivors of autologous or allogeneic blood or marrow transplantation performed between 1974 and 2014 and identified the role of demographic and clinical factors associated with HPV-related squamous cell carcinomas using proportional subdistribution hazards model for competing risks. Standardized incidence ratio was used to compare the risk of HPV-related squamous cell carcinoma with age-, sex-, and calendar-specific incidence in the general population.
RESULTS
The median age at transplantation was 46 years (range = 0-78 years); 58.5% (n = 4642) were male, and 72.2% (n = 5727) were non-Hispanic White. Half (50.3%, n = 3991) of the patients had received an allogeneic blood or marrow transplantation. The standardized incidence ratio for oropharyngeal squamous cell carcinomas (n = 53) was 1.8 (95% confidence interval [CI] = 1.3 to 2.3) and for cervical squamous cell carcinoma among female blood or marrow transplantation recipients (n = 26) was 9.4 (95% CI = 6.3 to 13.6) compared with the general US population. The hazard of an HPV-related squamous cell carcinoma was higher among allogeneic blood or marrow transplantation recipients with chronic graft vs host disease (any HPV-related squamous cell carcinoma: HR = 6.24, 95% CI = 3.11 to 12.50; oropharyngeal: HR = 4.85, 95% CI = 2.11 to 11.15; cervical: HR = 4.98, 95% CI = 1.65 to 15.00; reference: autologous blood or marrow transplantation). Pre-blood or marrow transplantation radiation increased the risk of oropharyngeal squamous cell carcinoma (HR = 2.98, 95% CI = 1.57 to 5.65).
CONCLUSION
These findings underscore the importance of risk-based HPV vaccination and surveillance after blood or marrow transplantation.
背景
人乳头瘤病毒（HPV）与普通人群中多种鳞状细胞癌风险增加相关。血液或骨髓移植幸存者后续发生可能与HPV相关的鳞状细胞癌（宫颈癌、口咽癌、外阴癌、阴道癌、肛门癌和阴茎癌；HPV相关鳞状细胞癌）的风险仍未知。
方法
我们确定了1974年至2014年间接受自体或异体血液或骨髓移植的7936名2年幸存者中HPV相关鳞状细胞癌的风险，并使用竞争风险的比例亚分布风险模型确定了与HPV相关鳞状细胞癌相关的人口统计学和临床因素的作用。标准化发病比用于比较HPV相关鳞状细胞癌与普通人群中按年龄、性别和日历时间特定发病率的风险。
结果
移植时的中位年龄为46岁（范围=0-78岁）；58.5%（n=4642）为男性，72.2%（n=5727）为非西班牙裔白人。一半（50.3%，n=3991）的患者接受了异体血液或骨髓移植。与美国普通人群相比，口咽鳞状细胞癌（n=53）的标准化发病比为1.8（95%置信区间[CI]=1.3至2.3），女性血液或骨髓移植受者中宫颈癌（n=26）的标准化发病比为9.4（95%CI=6.3至13.6）。慢性移植物抗宿主病的异体血液或骨髓移植受者发生HPV相关鳞状细胞癌的风险更高（任何HPV相关鳞状细胞癌：HR=6.24，95%CI=3.11至12.50；口咽癌：HR=4.85，95%CI=2.11至11.15；宫颈癌：HR=4.98，95%CI=1.65至15.00；对照：自体血液或骨髓移植）。血液或骨髓移植前放疗增加了口咽鳞状细胞癌的风险（HR=2.98，95%CI=1.57至5.65）。
结论
这些发现强调了基于风险的HPV疫苗接种和血液或骨髓移植后监测的重要性。
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