Synchronous cancers in patients with head and neck cancer Risks in the Era of Human Papillomavirus-Associated Oropharyngeal Cancer
Synchronous cancers in patients with head and neck cancer Risks in the Era of Human Papillomavirus-Associated Oropharyngeal Cancer
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DOI：
10.1002/cncr.27988
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发表时间：
2013-05-15
期刊：
影响因子：
6.2
通讯作者：
Morris, Luc G. T.
中科院分区：
文献类型：
--
作者：
Jain, Kunal S.;Sikora, Andrew G.;Morris, Luc G. T.
背景：第二原发恶性肿瘤（SPM）是头颈部鳞状细胞癌（HNSCC）幸存者死亡的主要原因。同步SPM具有重要的临床意义，因为它们可能在诊断索引癌症时通过筛查程序识别。最近，人乳头瘤病毒（HPV）已成为口咽头颈部鳞状细胞癌（HNSCC）的一个独特的危险因素，不同于经典的烟草/酒精相关的HNSCC，这表明也可能有不同的模式同步SPM。方法：作者在国家癌症研究所监测、流行病学和最终结果登记处（1979-2008）的64，673例患者中进行了一项基于人群的队列研究，确定了在HPV相关口咽HNSCC流行出现之前和之后诊断的HNSCC患者中同步SPM的风险。使用标准化发病率比（SIR）和每100例患者的超额绝对风险计算超额风险。结果：在HNSCC患者中，同步SPM的SIR为5.0，相当于每100例患者中有2.62例多余病例。第二种癌症的最高额外风险部位是头颈部（SIR，41.4），其次是食管（SIR，21.8）和肺（SIR，7.4）。口咽部HNSCC患者的同步SPM风险随时间显著变化。在20世纪70年代和80年代，口咽癌是SPM的最高风险。风险在20世纪90年代开始急剧下降;目前，口咽癌的同步SPM风险最低。结论：目前的数据与口咽部HNSCC的病因转变一致，从主要与上呼吸消化道粘膜显著癌变相关的烟草相关恶性肿瘤转变为主要由致癌人乳头瘤病毒引起的恶性肿瘤。癌症2013。(c)2013年美国癌症协会
BACKGROUND: Second primary malignancies (SPMs) are the leading cause of death in survivors of head and neck squamous cell carcinoma (HNSCC). Synchronous SPMs are of significant clinical interest because they potentially can be identified by screening procedures at the time of diagnosis of the index cancer. Recently, human papillomavirus (HPV) has emerged as a distinct risk factor for oropharyngeal head and neck squamous cell carcinoma (HNSCC), differing from classic tobacco/alcohol-associated HNSCC, suggesting that there also may be distinct patterns of synchronous SPMs. METHODS: The authors performed a population-based cohort study in 64,673 patients in the National Cancer Institute Surveillance, Epidemiology, and End Results registry (1979-2008), defining risks of synchronous SPM in patients with HNSCC who were diagnosed before and after the emergence of prevalent HPV-associated oropharyngeal HNSCC. Excess risk was calculated using standardized incidence ratios (SIR) and excess absolute risk per 100 patients. RESULTS: Among patients with HNSCC, the SIR of synchronous SPM was 5.0, corresponding to 2.62 excess cases per 100 patients. The site with the highest excess risk of a second cancer was the head and neck (SIR, 41.4), followed by the esophagus (SIR, 21.8), and lung (SIR, 7.4). The risk of synchronous SPM changed markedly over time for patients with oropharyngeal HNSCC. In the 1970s and 1980s, oropharyngeal cancers carried the highest risk of SPM. Risk began to dramatically decline in the 1990s; and currently, oropharyngeal cancers carry the lowest risk of synchronous SPM. CONCLUSIONS: The current data are consistent with the etiologic shift of oropharyngeal HNSCC, from a primarily tobacco-associated malignancy associated with significant field cancerization of the upper aerodigestive mucosa, to a malignancy primarily caused by oncogenic human papillomavirus. Cancer 2013. (c) 2013 American Cancer Society.