Reduced impact of nodal metastases as a prognostic factor for tonsil cancer in the HPV era.
Reduced impact of nodal metastases as a prognostic factor for tonsil cancer in the HPV era.
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在 HPV 时代，淋巴结转移作为扁桃体癌预后因素的影响减少。
DOI：
10.1007/s00405-013-2796-2
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Sikora,AndrewG
中科院分区：
文献类型：
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作者：
Vila,PeterM;Stucken,ChazL;Morris,LucGT;Posner,MarshallR;Genden,EricM;Boffetta,Paolo;Sikora,AndrewG
转移性淋巴结是头颈部鳞状细胞癌预后不良的因素。在这项研究中，我们验证了这样一个假设，即在HPV占主导地位的时代，淋巴结转移对扁桃体癌生存率的影响降低。从SEER数据库中获得1988年至2007年扁桃体和口腔SCC的发病率和死亡率数据。根据已发表的文献，我们将1988年至1997年的扁桃体癌病例视为HPV前队列（N= 752），将1998年至2007年的扁桃体癌病例视为HPV占主导地位的队列（N= 2，755）。比较两个队列，扁桃体SCC的Kaplan-Meier 5年总生存率（OS）从54.0%提高到74.3%（p< 0.0001），癌症特异性生存率（CSS）从66.0%提高到82.9%（p< 0.0001）。根据LN受累分层显示，HPV占优势的队列中OS改善，（63.6 vs. 79.7%，p< 0.0001），2 - 3（54.2 vs. 75.9%，p< 0.0001），4至8个（40.3 vs. 68.9%，p< 0.0001），以及大于8个阳性淋巴结（25.5 vs. 41.9%，p< 0.0001）。虽然转移性淋巴结仍然对预后有负面影响，但在HPV占主导地位的时代，它们对OPC生存率的影响已经减弱。这一发现为进一步研究确定HPV状态的OPC队列中LN转移的预后意义提供了依据，并支持HPV相关OPC是一种不同于“经典”OPC的疾病，具有独特的预后特征的概念。
Metastatic lymph nodes (LN) are an adverse prognostic factor in head and neck squamous cell carcinoma (SCC). In this study, we tested the hypothesis that nodal metastases have reduced impact on survival in tonsil cancer in the HPV-predominant era. Incidence and mortality data of tonsil and oral cavity SCC between 1988 and 2007 were obtained from the SEER database. Based on published literature, we considered cases of tonsil cancer from 1988 to 1997 as the pre-HPV cohort (N= 752), and 1998–2007 as the HPV-predominant cohort (N= 2,755). Comparing the two cohorts, Kaplan–Meier 5-year overall survival (OS) for tonsil SCC improved from 54.0 to 74.3 % (p< 0.0001), and cancer-specific survival (CSS) improved from 66.0 to 82.9 % (p< 0.0001). Stratifying by LN involvement showed improved OS in the HPV-predominant cohort with one (63.6 vs. 79.7 %,p< 0.0001), two to three (54.2 vs. 75.9 %,p< 0.0001), four to eight (40.3 vs. 68.9 %,p< 0.0001), and greater than eight positive nodes (25.5 vs. 41.9 %,p< 0.0001). While metastatic LNs still negatively affect prognosis, their impact on OPC survival has diminished in the HPV-predominant era. This finding provides a rationale for additional studies of the prognostic significance of LN metastases in OPC cohorts of defined HPV status, and supports the concept that HPV-related OPC is a disease distinct from “classical” OPC, with unique prognostic features.