Classical risk factors, but not HPV status, predict survival after chemoradiotherapy in advanced head and neck cancer patients.
Classical risk factors, but not HPV status, predict survival after chemoradiotherapy in advanced head and neck cancer patients.
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经典的危险因素，但不是HPV状态，可以预测晚期和颈癌患者化学放疗后的生存。
DOI：
10.1007/s00432-016-2203-7
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发表时间：
2016-10
影响因子：
3.6
通讯作者：
Saussez S
中科院分区：
文献类型：
--
作者：
Descamps G;Karaca Y;Lechien JR;Kindt N;Decaestecker C;Remmelink M;Larsimont D;Andry G;Hassid S;Rodriguez A;Khalife M;Journe F;Saussez S
尽管伴随放化疗（CCRT）的出现，晚期头颈部鳞状细胞癌（HNSCC）患者的预后仍然特别差。传统上，与人乳头瘤病毒（HPV）相关的HNSCC，特别是口咽癌，在未感染患者中表现出比HNSCC更好的治疗结果，从而引发了对当前疗法降级的呼吁。为了改善HNSCC患者的管理，我们的目的是确定活动性HPV感染对重度吸烟和饮酒人群中CCRT后患者反应、复发和生存的影响。通过替代型特异性E6/E7 qPCR和p16免疫组化检测218例晚期HNSCC患者（大多数为吸烟者和/或饮酒者，接受CCRT治疗）石蜡包埋样本中HPV DNA的存在。通过Kaplan-Meier分析以及单变量和多变量考克斯回归分析，根据HPV状态和临床数据评估CCRT的应答与患者结局之间的相关性。型特异性E6/E7 PCR显示20%的HNSCC中HPV阳性。关于HPV状态，我们没有发现任何显着的关系，对治疗的无进展生存期或总生存期。然而，我们观察到与不饮酒者（p = 0.003）和不吸烟者（p = 0.03）相比，酒精和烟草消费者的预后明显较差。生存分析还显示，IV期患者的结局受损（p = 0.007），特别是口腔癌、下咽癌和口咽癌患者（p = 0.001）。当患者在治疗期间暴露于烟草和酒精时，HNSCC的死亡风险显著增加，无论HPV状态如何。
Despite the advent of concomitant chemoradiotherapy (CCRT), the prognosis of advanced head and neck squamous cell carcinoma (HNSCC) patients remains particularly poor. Classically, HNSCC, especially oropharyngeal carcinomas, associated with human papillomavirus (HPV) exhibits better treatment outcomes than HNSCCs in non-infected patients, eliciting a call for the de-escalation of current therapies. To improve the management of HNSCC patients, we aimed to determine the impact of active HPV infection on patient response, recurrence and survival after CCRT in a population of heavy tobacco and alcohol consumers. Paraffin-embedded samples from 218 advanced HNSCC patients, mostly smokers and/or drinkers treated by CCRT, were tested for the presence of HPV DNA by surrogate type-specific E6/E7 qPCR and p16 immunohistochemistry. Associations between the response to CCRT and patient outcomes according to HPV status and clinical data were evaluated by Kaplan–Meier analysis and both univariate and multivariate Cox regression. Type-specific E6/E7 PCR demonstrated HPV positivity in 20 % of HNSCC. Regarding HPV status, we did not find any significant relation with response to therapy in terms of progression-free survival or overall survival. However, we observed a significantly worse prognosis for consumers of alcohol and tobacco compared to nondrinkers (p = 0.003) and non-smokers (p = 0.03). Survival analyses also revealed that the outcome is compromised in stage IV patients (p = 0.007) and, in particular, for oral cavity, hypopharynx and oropharynx carcinoma patients (p = 0.001). The risk of death from HNSCC significantly increases when patients are exposed to tobacco and alcohol during their therapy, regardless of HPV status.
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影响因子：
5.3
作者：
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通讯作者：
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