Human Papillomavirus and Rising Oropharyngeal Cancer Incidence in the United States
Human Papillomavirus and Rising Oropharyngeal Cancer Incidence in the United States
复制标题
DOI：
10.1200/jco.2011.36.4596
复制
发表时间：
2011-11-10
影响因子：
45.3
通讯作者：
Gillison, Maura L.
中科院分区：
文献类型：
--
作者：
Chaturvedi, Anil K.;Engels, Eric A.;Gillison, Maura L.
在美国，最近口咽癌发病率和生存率的增加被归因于人乳头瘤病毒（HPV）感染，但缺乏经验证据。（1984-2004年）由监测、流行病学、和最终结果（SEER）残留组织储存库计划，通过使用聚合酶链反应和基因分型（Inno-LiPA），HPV 16病毒载量和HPV 16 mRNA表达。使用logistic回归估计四个日历期间HPV患病率的趋势。观察到的HPV患病率被重新加权到所有口咽癌的癌症登记，以解释非随机选择和计算发病率趋势。HPV阳性和HPV阴性患者的生存率进行了比较，通过使用Kaplan-Meier和多变量考克斯回归analysis.ResultsHPV在口咽癌的患病率显着增加，无论在日历时间的HPV检测分析（P趋势<0.05）。例如，Inno-LiPA的HPV患病率从1984年至1989年的16.3%增加到2000年至2004年的71.7%。HPV阳性患者的中位生存期明显长于HPV阴性患者（131 v20个月;对数秩P <0.001;校正风险比，0.31; 95%CI，0.21 - 0.46）。HPV阳性患者（P = 0.003）的生存率在各日历期间显著增加，但HPV阴性患者（P = 0.18）则无此情况。HPV阳性口咽癌的人口发病率增加了225% 1988年至2004年（95% CI，208%至242%）（从每10万人0.8例降至每10万人2.6例），HPV阴性癌症的发病率下降了50%（95% CI，47%至53%;从2.0/100，000至1.0/100，000）。如果近期的发病趋势持续下去，到2020年，HPV阳性口咽癌的年发病人数有望超过宫颈癌的年发病人数。结论自1984年以来，美国口咽癌的发病率和生存率的增加是由HPV感染引起的。J Clin Oncol 29：4294-4301. (C)2011年美国临床肿瘤学会
PurposeRecent increases in incidence and survival of oropharyngeal cancers in the United States have been attributed to human papillomavirus (HPV) infection, but empirical evidence is lacking.Patients and MethodsHPV status was determined for all 271 oropharyngeal cancers (1984-2004) collected by the three population-based cancer registries in the Surveillance, Epidemiology, and End Results (SEER) Residual Tissue Repositories Program by using polymerase chain reaction and genotyping (Inno-LiPA), HPV16 viral load, and HPV16 mRNA expression. Trends in HPV prevalence across four calendar periods were estimated by using logistic regression. Observed HPV prevalence was reweighted to all oropharyngeal cancers within the cancer registries to account for nonrandom selection and to calculate incidence trends. Survival of HPV-positive and HPV-negative patients was compared by using Kaplan-Meier and multivariable Cox regression analyses.ResultsHPV prevalence in oropharyngeal cancers significantly increased over calendar time regardless of HPV detection assay (P trend < .05). For example, HPV prevalence by Inno-LiPA increased from 16.3% during 1984 to 1989 to 71.7% during 2000 to 2004. Median survival was significantly longer for HPV-positive than for HPV-negative patients (131 v 20 months; log-rank P < .001; adjusted hazard ratio, 0.31; 95% CI, 0.21 to 0.46). Survival significantly increased across calendar periods for HPV-positive (P = .003) but not for HPV-negative patients (P = .18). Population-level incidence of HPV-positive oropharyngeal cancers increased by 225% (95% CI, 208% to 242%) from 1988 to 2004 (from 0.8 per 100,000 to 2.6 per 100,000), and incidence for HPV-negative cancers declined by 50% (95% CI, 47% to 53%; from 2.0 per 100,000 to 1.0 per 100,000). If recent incidence trends continue, the annual number of HPV-positive oropharyngeal cancers is expected to surpass the annual number of cervical cancers by the year 2020.ConclusionIncreases in the population-level incidence and survival of oropharyngeal cancers in the United States since 1984 are caused by HPV infection. J Clin Oncol 29: 4294-4301. (C) 2011 by American Society of Clinical Oncology