Surgical salvage improves overall survival for patients with HPV-positive and HPV-negative recurrent locoregional and distant metastatic oropharyngeal cancer.
Surgical salvage improves overall survival for patients with HPV-positive and HPV-negative recurrent locoregional and distant metastatic oropharyngeal cancer.
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DOI：
10.1002/cncr.29323
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发表时间：
2015-06-15
期刊：
影响因子：
6.2
通讯作者：
Fakhry, Carole
中科院分区：
文献类型：
--
作者：
Guo, Theresa;Qualliotine, Jesse R.;Ha, Patrick K.;Califano, Joseph A.;Kim, Young;Saunders, John R.;Blanco, Ray G.;D'Souza, Gypsyamber;Zhang, Zhe;Chung, Christine H.;Kiess, Ana;Gourin, Christine G.;Koch, Wayne;Richmon, Jeremy D.;Agrawal, Nishant;Eisele, David W.;Fakhry, Carole
关键词：
人乳头瘤病毒（HPV）肿瘤状态和手术挽救与复发性口咽鳞状细胞癌（OPSCC）患者预后改善相关。目前关于手术类型和手术对远处转移性疾病的影响的数据有限。回顾性分析2000-2012年间两家机构复发性OPSCC患者。P16免疫组织化学和/或原位杂交，如临床可用，用于确定HPV肿瘤状态。比较两组患者的临床特点、复发部位分布及治疗方式。采用Kaplan-Meier和Cox比例风险法检测总生存率。该研究包括108例患者，其中65例局部复发，43例远处转移性首次复发。多数为hpv阳性（n=80）。hpv阳性肿瘤状态与复发时间延长相关（p<0.01）。复发的解剖部位分布没有因HPV肿瘤状态而异。hpv阳性肿瘤状态（校正HR [aHR] 0.23 (95%CI 0.09-0.58), p=0.002）、较长的复发时间（≥1年；aHR 0.36 (0.18-0.74), p=0.006）和手术挽救（aHR 0.26 (0.12-0.61), p=0.002）与复发后总生存率独立相关。与非手术治疗相比，手术挽救与局部（aHR 0.15 (0.04-0.56), p=0.005）和远处转移性复发（aHR 0.19 (0.05-0.75), p=0.018）的总生存率均独立相关。手术挽救与复发性局部和远处转移性OPSCC的总生存率提高有关，与HPV肿瘤状态无关。需要进一步的前瞻性数据来证实手术挽救对远处转移的作用。
Human papillomavirus (HPV) tumor status and surgical salvage are associated with improved prognosis for patients with recurrent oropharyngeal squamous cell carcinoma (OPSCC). Current data regarding types of surgery and the impact of surgery for distant metastatic disease are limited. A retrospective analysis of patients with recurrent OPSCC from two institutions between 2000-2012 was performed. P16 immunohistochemistry and/or in situ hybridization, as clinically available, were used to determine HPV tumor status. Clinical characteristics, distribution of recurrence site and treatment modalities were compared by HPV tumor status. Overall survival was examined by Kaplan-Meier and Cox proportional hazards methods. The study included 108 patients with 65 locoregional and 43 distant metastatic first recurrences. The majority were HPV-positive (n=80). HPV-positive tumor status was associated with longer time to recurrence (p<0.01). Anatomic site distribution of recurrences did not differ by HPV tumor status. HPV-positive tumor status (adjusted HR [aHR] 0.23 (95%CI 0.09-0.58), p=0.002), longer time to recurrence (≥1 year; aHR 0.36 (0.18-0.74), p=0.006), and surgical salvage (aHR 0.26 (0.12-0.61), p=0.002) were independently associated with overall survival after recurrence. Surgical salvage was independently associated with improved overall survival compared to non-surgical treatment in both locoregional (aHR 0.15 (0.04-0.56), p=0.005) and distant metastatic recurrence (aHR 0.19 (0.05-0.75), p=0.018). Surgical salvage is associated with improved overall survival for recurrent locoregional and distant metastatic OPSCC, independent of HPV tumor status. Further prospective data is needed to confirm the role of surgical salvage for distant metastases.
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影响因子：
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