A Hidden Epidemic of "Intermediate Risk" Oropharynx Cancer
A Hidden Epidemic of "Intermediate Risk" Oropharynx Cancer
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DOI：
10.1002/lio2.316
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发表时间：
2019-10-17
影响因子：
1.9
通讯作者：
Sikora, Andrew G.
中科院分区：
文献类型：
--
作者：
Sandulache, Vlad C.;Wilde, David C.;Sikora, Andrew G.
口咽鳞状细胞癌（OPSCC）的发病率在美国和世界各地迅速增加，在很大程度上是由人乳头瘤病毒（HPV）感染引起的。HPV相关的OPSCC（HPV+OPSCC）已被证明相对于烟草相关的OPSCC具有改善的治疗反应。然而，患者生存率的改善并不一致。美国和世界各地的OPSCC患者亚组的肿瘤学结局仍然较差。尽管这种现象的驱动因素尚不清楚，但越来越多的证据表明烟草暴露在调节HPV+OPSCC临床结局中起着重要作用。方法复习相关文献。结果我们讨论了烟草和HPV暴露在OPSCC的背景下，潜在的生物学和流行病学之间的相互作用。多个回顾性和前瞻性队列研究表明，有烟草暴露史的HPV+OPSCC患者对治疗的反应和临床结局与HPV+OPSCC非吸烟者不同，这在未来十年内提出了需要解决的临床和科学挑战。结论烟草暴露和HPV感染在OPSCC背景下的相互作用对标准治疗方案和新型治疗方法的开发具有重要意义，特别是那些包含免疫调节剂的治疗方法。
Objectives Oropharyngeal squamous cell carcinoma (OPSCC) incidence is rapidly increasing in the United States and around the world, driven in large part by infection with the human papillomavirus (HPV). HPV associated OPSCC (HPV+OPSCC) has been shown to have improved response to treatment relative to tobacco-associated OPSCC. However, improvement in patient survival has not been uniform. Subsets of OPSCC patients in the US and around the world continue to have poor oncologic outcomes. Although the drivers of this phenomenon remain unclear, there is increasing evidence that tobacco exposure plays an important role in modulating HPV+OPSCC clinical outcomes. Methods We conducted a review of the literature. Results We discuss the potential biological and epidemiological interplay between tobacco and HPV exposure in the context of OPSCC. Multiple retrospective and prospective cohorts show that HPV+OPSCC patients with a history of tobacco exposure have response to treatment and clinical outcomes distinct from HPV+OPSCC non-smokers which poses clinical and scientific challenges to be addressed over the next decade. Conclusions The interaction between tobacco exposure and HPV infection in the context of OPSCC has significant implications for both standard of care treatment regimens and development of novel therapeutic approaches, in particular those which incorporate immunomodulatory agents.