Human papillomavirus and head and neck carcinomas: focus on evidence in the babel of published data.
Human papillomavirus and head and neck carcinomas: focus on evidence in the babel of published data.
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DOI：
10.14639/0392-100x-853
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发表时间：
2016-08
期刊：
影响因子：
--
通讯作者：
Benazzo M
中科院分区：
文献类型：
--
作者：
Morbini P;Benazzo M
人乳头瘤病毒（HPV）相关的鳞状细胞癌的口咽部是一个明确的实体，主要影响年轻到中年男性非吸烟者。它通常与有利的结局相关，因此，针对该患者亚组提出了强度较低的治疗方法。HPV相关口咽癌的发病率在大多数西方国家迅速增加，但意大利人群的详细流行病学数据不可用。此外，在其他头颈部区域中，口腔高度异型增生和癌症的比例较小，似乎取决于HPV感染，而其在喉癌中的作用被认为不太相关。HPV依赖性肿瘤转化依赖于感染宿主细胞中病毒癌基因的表达，其只能通过病毒癌基因mRNA鉴定直接记录。如何从临床和实验室诊断的角度对这些患者进行分类的共识仍然有限，基于一种或多种诊断技术的不同方法包括p16免疫染色，原位杂交和病毒DNA的聚合酶链反应（PCR）扩增。依赖于口腔和口咽脱落细胞中HPV感染的鉴定的早期诊断的可能性迄今为止提供了不令人满意的结果，尽管治疗后病毒持续存在与复发风险相关。目前，没有足够的数据来记录扁桃体HPV感染到口咽癌发展的自然史和进展，并明确定义传播和风险暴露的方式，其中性行为似乎起着相关的作用。HPV疫苗接种的普及及其对男女的管理无疑将在未来几年大大改变HPV相关头颈癌的流行病学。
Human papillomavirus (HPV)-associated squamous cell carcinoma of the oropharynx is a well-defined entity mostly affecting young to middle-aged male non-smokers. It is generally associated with a favourable outcome, and for this reason a less intensive therapeutic approach has been proposed for this subset of patients. The incidence of HPV-associated oropharyngeal cancers is rapidly increasing in most Western countries, but detailed epidemiological data are not available for the Italian population. Furthermore, among other head and neck regions, a smaller proportion of oral high-grade dysplasia and cancers seems to depend on HPV infection, whereas its role in laryngeal cancer is recognised as less relevant. HPV-dependent neoplastic transformation depends on the expression of viral oncogenes in the infected host cell that can only be directly documented through viral oncogene mRNA identification. The consensus on how to classify these patients from clinical and laboratory diagnostic points of view is still limited, with different approaches based on one or more diagnostic techniques including p16 immunostaining, in situ hybridisation and polymerase chain reation (PCR) amplification of viral DNA. The possibility of early diagnosis relying on the identification of HPV infection in oral and oropharyngeal exfoliated cells has so far provided unsatisfactory results, although viral persistence after treatment has been associated with risk of recurrence. Presently, sufficient data are not available to document the natural history and progression from tonsillar HPV infection to oropharyngeal cancer development, and to clearly define the modality of transmission and risk exposure, among which sexual behaviours appear to play a relevant role. The diffusion of HPV vaccination and its administration to both genders will undoubtedly dramatically modify the epidemiology of HPV-related head and neck cancers in the coming years.