Tobacco use in human papillomavirus-positive advanced oropharynx cancer patients related to increased risk of distant metastases and tumor recurrence.
Tobacco use in human papillomavirus-positive advanced oropharynx cancer patients related to increased risk of distant metastases and tumor recurrence.
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DOI：
10.1158/1078-0432.ccr-09-2350
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发表时间：
2010-02-15
期刊：
影响因子：
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通讯作者：
Carey TE
中科院分区：
文献类型：
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作者：
Maxwell JH;Kumar B;Feng FY;Worden FP;Lee JS;Eisbruch A;Wolf GT;Prince ME;Moyer JS;Teknos TN;Chepeha DB;McHugh JB;Urba SG;Stoerker J;Walline HM;Kurnit DM;Cordell KG;Davis SJ;Ward PD;Bradford CR;Carey TE
这项研究的目的是研究在HPV阳性的口咽鳞状细胞癌(SCCOP)患者中，在放化疗完全有效后，吸烟对疾病复发(局部/区域复发、远处转移或二次原发)的影响。在1999至2007年间，124名晚期SCCOP患者(86%为IV期)和足够的肿瘤组织用于HPV分析，他们被纳入这项研究，他们参加了密歇根大学连续两种治疗方案之一。患者被归类为从未、以前或现在吸烟的人。主要终点是疾病复发风险和复发时间；次要终点是特定疾病的存活率和总体存活率。102例(82.3%)为HPV阳性肿瘤。超过三分之二(68%)的HPV阳性肿瘤患者是吸烟者。在人乳头瘤病毒阳性患者中，现在吸烟的人比从不吸烟的人有显著更高的疾病复发风险(危险比=5.2%；可信区间[1.124.4]；p=0.038)。35%的HPV阳性吸烟者曾经复发，相比之下，HPV阳性从未吸烟者和HPV阴性患者的这一比例仅为6%和50%。所有人乳头瘤病毒阴性患者都是吸烟者，与人乳头瘤病毒阳性患者相比，他们的复发时间显著缩短(p=0.002)，疾病特异性存活率(p=0.004)和总存活率(p<；0.001)显著降低。与人乳头瘤病毒阳性的从不吸烟的人相比，那些有吸烟史的人表现出特定疾病存活率降低的趋势(p=0.064)，但总体存活率没有下降(p=0.221)。与从不吸烟的人相比，目前患有晚期HPV阳性SCCOP的烟草使用者的疾病复发风险更高。
The goal of this study was to examine the effect of tobacco use on disease recurrence (local/regional recurrence, distant metastasis, or second primary) among HPV-positive patients with squamous cell carcinoma of the oropharynx (SCCOP) following a complete response to chemoradiation therapy. Between 1999 and 2007, 124 patients with advanced SCCOP (86% with stage IV) and adequate tumor tissue for HPV analysis who were enrolled in one of two consecutive University of Michigan treatment protocols were prospectively included in this study. Patients were categorized as never, former, or current tobacco users. The primary end-points were risk of disease recurrence and time to recurrence; secondary end-points were disease-specific survival and overall survival. One hundred and two patients (82.3%) had HPV-positive tumors. Over two-thirds (68%) of patients with HPV-positive tumors were tobacco users. Among HPV-positive patients, current tobacco users were at significantly higher risk of disease recurrence than never-tobacco users (hazard ratio = 5.2; confidence interval [1.1-24.4]; p=0.038). Thirty-five percent of HPV-positive ever tobacco users recurred compared to only 6% of HPV-positive never users and 50% of HPV-negative patients. All HPV-negative patients were tobacco users and had significantly shorter times to recurrence (p=0.002) and reduced disease-specific survival (p=0.004) and overall survival (p<0.001) compared to HPV-positive patients. Compared to HPV-positive never-tobacco users, those with a tobacco history showed a trend for reduced disease-specific survival (p=0.064) but not overall survival (p=0.221). Current tobacco users with advanced, HPV-positive SCCOP are at higher risk of disease recurrence compared to never-tobacco users.