HPV impacts survival of stage IVC non-oropharyngeal HNSCC cancer patients.
HPV impacts survival of stage IVC non-oropharyngeal HNSCC cancer patients.
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DOI：
10.15761/ohns.1000160
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Witek ME
中科院分区：
文献类型：
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作者：
Burr AR;Harari PM;Ko HC;Chen S;Yu M;Baschnagel AM;Kimple RJ;Witek ME
人乳头瘤病毒（HPV）状态是口咽鳞状细胞癌（OPSCC）和非转移性头颈部非OPSCC患者的有利预后标志。我们评估了HPV状态对IVC期非OPSCC患者总生存期（OS）的影响。在国家癌症数据库中确定了2010-2013年期间诊断为IVC期非OPSCC和已知HPV状态的患者。进行单变量和多变量分析以确定与OS相关的因素。使用倾向评分加权Kaplan-Meier估计来校正OS分析中的混杂因素。敏感性分析采用多重插补方法。我们确定了708例IVC期非OPSCC患者，其中30%为HPV阳性。HPV阴性患者未校正的中位生存期为10.3个月，HPV阳性患者为21.4个月（p<0.0001）。多变量分析显示，年龄≥ 65岁和肿瘤直径与OS较差相关（p<0.05），而治疗与未治疗和HPV阳性状态与OS改善相关（p<0.001）。HPV阴性和HPV阳性患者的校正中位生存期分别为11.1个月和23.8个月（p<0.001）。在未调整的亚组分析中，与HPV阴性患者相比，HPV阳性口腔疾病患者表现出改善的结局（p<0.0001），而HPV阳性下咽部（p<0.06）和喉部（p<0.12）患者表现出改善OS的趋势。在敏感性分析中，与HPV阳性相关的生存优势保持不变（p<0.01）。这些数据表明，在IVC期疾病的非OSPCC患者中，HPV状态与OS之间存在有临床意义的相关性。在缺乏随机数据的情况下，这些发现支持在临床决策，临床试验设计和患者预后咨询中积极考虑HPV状态。
Human papillomavirus (HPV) status is a favorable prognostic marker for patients with oropharyngeal squamous cell carcinoma (OPSCC) and non-metastatic head and neck non-OPSCC. We evaluated the impact of HPV status on overall survival (OS) for patients with Stage IVC non-OPSCC. Patients diagnosed with Stage IVC non-OPSCC and known HPV status between 2010–2013 were identified in the National Cancer Database. Univariate and multivariate analyses were performed to determine factors associated with OS. Propensity score-weighted Kaplan-Meier estimation was used to adjust for confounders in OS analyses. Multiple imputation method was used for sensitivity analysis. We identified 708 patients with Stage IVC non-OPSCC with 30% being HPV-positive. Unadjusted median survival was 10.3 months for HPV-negative patients and 21.4 months for HPV-positive patients (p<0.0001). Age ≥ 65 and tumor diameter were associated with worse OS (p<0.05) while treatment versus no treatment and HPV-positive status were associated with improved OS on multivariate analysis (p<0.001). Adjusted median survival for patients with HPV-negative and HPV-positive disease was 11.1 months and 23.8 months, respectively (p<0.001). On unadjusted subgroup analysis, patients with HPV-positive oral cavity disease exhibited improved outcomes (p<0.0001) while HPV-positive hypopharynx (p<0.06) and larynx (p<0.12) patients exhibited a trend for improved OS compared to HPV-negative patients. The survival advantage associated with HPV positivity was maintained on sensitivity analysis (p<0.01). These data demonstrate a clinically meaningful association between HPV status and OS in patients with non-OSPCC presenting with Stage IVC disease. In the absence of randomized data, these findings support active consideration of HPV status in clinical decision making, clinical trial design, and patient counseling regarding prognosis.