Human Papillomavirus-related Carcinomas of the Sinonasal Tract
Human Papillomavirus-related Carcinomas of the Sinonasal Tract
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DOI：
10.1097/pas.0b013e3182698673
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发表时间：
2013-02-01
影响因子：
5.6
通讯作者：
Westra, William H.
中科院分区：
文献类型：
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作者：
Bishop, Justin A.;Guo, Theresa W.;Westra, William H.
高危型人乳头瘤病毒（HPV）是引起口咽部头颈部癌的一个既定原因。也有报道称，在一些鼻窦癌中也存在HPV，但对其总体发病率或临床病理特征知之甚少。在约翰霍普金斯医院的外科病理学档案中检索1995年至2011年发生在鼻窦道的所有癌症，并构建组织微阵列。对高危型HPV进行p16免疫组化分析和DNA原位杂交。从患者病历中提取人口统计学和临床结局数据。在161例鼻窦癌中，34例（21%）高危型HPV DNA阳性，包括16型（82%）、31/33型（12%）和18型（6%）。HPV阳性癌包括28例鳞状细胞癌和变异型（15例非角化或部分角化，4例乳头状，5例腺鳞状，4例基底细胞样），1例小细胞癌，1例鼻窦未分化癌和4例难以分类但表现出腺样囊性癌样特征的癌。p16免疫组化在59/161（37%）例中呈阳性，p16表达与HPV DNA的存在密切相关：34例HPV阳性肿瘤中有33例（97%）p16高表达，而127例HPV阴性肿瘤中只有26例（20%）p16阳性（P < 0.0001）。HPV相关癌发生于19例男性和15例女性，年龄33 ~ 87岁（平均54岁）。在HPV阳性组中观察到生存率改善的趋势（风险比= 0.58，95%置信区间[0.26，1.28]）。21%的鼻窦癌中存在高危型HPV，证实HPV是鼻窦癌的重要肿瘤学因子。虽然非角化性鳞状细胞癌是最常见的组织学类型，但HPV相关疾病的形态学谱很广，包括类似腺样囊性癌的变异。这些与HPV相关的鼻窦癌在危险因素、临床表现和治疗反应方面的独特性仍有待阐明。
High-risk human papillomavirus (HPV) is an established cause of head and neck carcinomas arising in the oropharynx. The presence of HPV has also been reported in some carcinomas arising in the sinonasal tract, but little is known about their overall incidence or their clinicopathologic profile. The surgical pathology archives of The Johns Hopkins Hospital were searched for all carcinomas arising in the sinonasal tract from 1995 to 2011, and tissue microarrays were constructed. p16 immunohistochemical analysis and DNA in situ hybridization for high-risk types of HPV were performed. Demographic and clinical outcome data were extracted from patient medical records. Of 161 sinonasal carcinomas, 34 (21%) were positive for high-risk HPV DNA, including type 16 (82%), type 31/33 (12%), and type 18 (6%). HPV-positive carcinomas consisted of 28 squamous cell carcinomas and variants (15 nonkeratinizing or partially keratinizing, 4 papillary, 5 adenosquamous, 4 basaloid), 1 small cell carcinoma, 1 sinonasal undifferentiated carcinoma, and 4 carcinomas that were difficult to classify but exhibited adenoid cystic carcinoma-like features. Immunohistochemistry for p16 was positive in 59/161 (37%) cases, and p16 expression strongly correlated with the presence of HPV DNA: 33 of 34 (97%) HPV-positive tumors exhibited high p16 expression, whereas only 26 of 127 (20%) HPV-negative tumors were p16 positive (P < 0.0001). The HPV-related carcinomas occurred in 19 men and 15 women ranging in age from 33 to 87 years (mean, 54 y). A trend toward improved survival was observed in the HPV-positive group (hazard ratio = 0.58, 95% confidence interval [0.26, 1.28]). The presence of high-risk HPV in 21% of sinonasal carcinomas confirms HPV as an important oncologic agent of carcinomas arising in the sinonasal tract. Although nonkeratinizing squamous cell carcinoma is the most common histologic type, there is a wide morphologic spectrum of HPV-related disease that includes a variant that resembles adenoid cystic carcinoma. The distinctiveness of these HPV-related carcinomas of the sinonasal tract with respect to risk factors, clinical behavior, and response to therapy remains to be clarified.