Predictors of overall survival in human papillomavirus-associated oropharyngeal cancer using the National Cancer Data Base
Predictors of overall survival in human papillomavirus-associated oropharyngeal cancer using the National Cancer Data Base
复制标题
DOI：
10.1016/j.oraloncology.2016.02.011
复制
发表时间：
2016-05-01
期刊：
影响因子：
4.8
通讯作者：
Karam, Sana D.
中科院分区：
文献类型：
--
作者：
Amini, Arya;Jasem, Jagar;Karam, Sana D.
目的：本研究确定了与HPV阳性口咽鳞状细胞癌（OPSCC）相关的临床特征，并评估了在国家癌症数据库（NCDB）中接受确定性治疗的HPV阳性患者的总生存期（OS）的预测因子。材料和方法：手术、放疗（RT）、化疗-RT（CRT）、手术+ RT、手术+ CRT（S-CRT）。采用考克斯比例风险模型进行多因素分析（MVA），评估HPV感染状态对OS的预测作用。中位随访时间为23.7个月（范围：1.0-54.5）。HPV阳性与阴性的未校正2年OS率分别为93.1%与77.8%（p < 0.001），校正后风险比为0.44（95%CI，0.36-0.53; p < 0.001）。MVA确定了包括CRT（HR，0.42; p = 0.024）和S-RT（HR，0.30; p = 0.024）但不是S-CRT（HR，0.51; p = 0.086）在内的多模式治疗是HPV阳性III-IVB期疾病OS改善的预测因素。包括S-CRT在内的综合治疗与HPV阴性OPSCC的OS延长相关。在HPV阳性的癌症中，淋巴结分期与OS的相关性很差。在HPV阴性（HR，2.11; p = 0.008）而不是HPV阳性OPSCC（HR，1.61; p = 0.154）中，存在阳性切缘和/或囊外延伸与更差的OS相关。结论：在NCDB中证实了HPV阳性OPSCC的既定人口统计学和临床特征。人群分析表明，AJCC分期与HPV阳性癌症的OS相关性较差，传统的高风险特征可能影响较小。双模式治疗在HPV阳性HNSCC中似乎是有益的。(C)2016爱思唯尔有限公司版权所有
Objectives: This study identifies clinical characteristics associated with HPV-positive oropharynx squamous cell carcinoma (OPSCC) and evaluates predictors of overall survival (OS) in HPV-positive patients undergoing definitive treatment within the National Cancer Data Base (NCDB).Material and methods: The NCDB was queried for patients P18 years old with OPSCC and known HPV status who underwent definitive treatment: surgery, radiation (RT), chemotherapy-RT (CRT), surgery + RT, surgery + CRT (S-CRT). Cox proportional hazards model was used for multivariate analysis (MVA) to evaluate predictors of OS by HPV status.Results: 3952 patients were included: 2454 (62%) were HPV-positive. Median follow up was 23.7 months (range, 1.0-54.5). Unadjusted 2-year OS rates for HPV-positive vs. negative were 93.1% vs. 77.8% (p < 0.001) with an adjusted hazard ratio of 0.44 (95% CI, 0.36-0.53; p < 0.001). MVA identified multimodality treatment including CRT (HR, 0.42; p = 0.024) and S-RT (HR, 0.30; p = 0.024), but not S-CRT (HR, 0.51; p = 0.086), as predictors for improved OS in HPV-positive stage III-IVB disease. Multimodality treatment including S-CRT was associated with longer OS in HPV-negative OPSCC. Nodal stage was poorly associated with OS in HPV-positive cancers. The presence of positive margins and/or extracapsular extension was associated with worse OS in HPV-negative (HR, 2.11; p = 0.008) but not HPV positive OPSCC (HR, 1.61; p = 0.154).Conclusion: The established demographic and clinical features of HPV-positive OPSCC were corroborated in the NCDB. Population analysis suggests that AJCC staging is poorly associated with OS in HPV-positive cancer, and traditional high-risk features may be less impactful. Bimodality therapy appears beneficial in HPV-positive HNSCC. (C) 2016 Elsevier Ltd. All rights reserved.