Human Papillomavirus and Overall Survival After Progression of Oropharyngeal Squamous Cell Carcinoma
Human Papillomavirus and Overall Survival After Progression of Oropharyngeal Squamous Cell Carcinoma
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DOI：
10.1200/jco.2014.55.1937
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发表时间：
2014-10-20
影响因子：
45.3
通讯作者：
Gillison, Maura
中科院分区：
文献类型：
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作者：
Fakhry, Carole;Zhang, Qiang;Gillison, Maura
人乳头瘤病毒（HPV）阳性口咽癌（OPC）患者的癌症进展风险相对于HPV阴性OPC降低，但尚不清楚进展后死亡风险是否同样降低。和/或接受铂类化疗后出现远处进展的患者有资格进行肿瘤p16状态与疾病进展后总生存期（OS）之间相关性的回顾性分析。采用Kaplan-Meier法估计发生率，并采用对数秩法进行比较;采用考克斯模型估计风险比（HR）。测试和模型分层治疗protocol.ResultsA共181例p16阳性（n = 105）或p16阴性（n = 76）OPC被纳入分析。p16阳性和p16阴性肿瘤患者的失败模式和中位进展时间（8.2 v7.3个月; P = 0.67）相似。在疾病进展后中位随访期为4.0年后，p16阳性OPC患者的生存率显著高于p16阴性患者（2年OS，54.6% vs27.6%;中位数，2.6 vs0.8年; P <0.001）。p16阳性肿瘤状态（HR，0.48; 95% CI，0.31 - 0.74）和接受挽救手术（HR，0.48; 95% CI; 0.27 - 0.84）疾病进展后死亡风险降低，而远处与局部进展相比（HR，1.99; 95% CI，1.28 - 3.09）风险增加，经过肿瘤分期和烟盒调整后-结论肿瘤HPV状态是疾病进展后OS的一个强有力的独立预测因子，应作为患者临床试验的分层因素复发或转移性OPC。
PurposeRisk of cancer progression is reduced for patients with human papillomavirus (HPV) -positive oropharynx cancer (OPC) relative to HPV-negative OPC, but it is unknown whether risk of death after progression is similarly reduced.Patients and MethodsPatients with stage III-IV OPC enrolled onto Radiation Therapy Oncology Group trials 0129 or RTOG 0522 who had known tumor p16 status plus local, regional, and/or distant progression after receiving platinum-based chemoradiotherapy were eligible for a retrospective analysis of the association between tumor p16 status and overall survival (OS) after disease progression. Rates were estimated by Kaplan-Meier method and compared by log-rank; hazard ratios (HRs) were estimated by Cox models. Tests and models were stratified by treatment protocol.ResultsA total of 181 patients with p16-positive (n = 105) or p16-negative (n = 76) OPC were included in the analysis. Patterns of failure and median time to progression (8.2 v 7.3 months; P = .67) were similar for patients with p16-positive and p16-negative tumors. After a median follow-up period of 4.0 years after disease progression, patients with p16-positive OPC had significantly improved survival rates compared with p16-negative patients (2-year OS, 54.6% v 27.6%; median, 2.6 v 0.8 years; P < .001). p16-positive tumor status (HR, 0.48; 95% CI, 0.31 to 0.74) and receipt of salvage surgery (HR, 0.48; 95% CI; 0.27 to 0.84) reduced risk of death after disease progression whereas distant versus locoregional progression (HR, 1.99; 95% CI, 1.28 to 3.09) increased risk, after adjustment for tumor stage and cigarette pack-years at enrollment.ConclusionTumor HPV status is a strong and independent predictor of OS after disease progression and should be a stratification factor for clinical trials for patients with recurrent or metastatic OPC.