Understanding the impact of high-risk human papillomavirus on oropharyngeal squamous cell carcinomas in Taiwan: A retrospective cohort study.
Understanding the impact of high-risk human papillomavirus on oropharyngeal squamous cell carcinomas in Taiwan: A retrospective cohort study.
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DOI：
10.1371/journal.pone.0250530
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Walline HM
中科院分区：
文献类型：
--
作者：
Lorenzatti Hiles G;Chang KP;Bellile EL;Wang CI;Yen WC;Goudsmit CM;Briggs HL;Thomas TB;Peters L;Afsari MA;Pinatti LM;Morris AC;Jawad N;Carey TE;Walline HM
人乳头瘤病毒（HPV）驱动的口咽鳞状细胞癌（OPSCC）在全球范围内不断增加。在台湾，HPV阳性的OPSCC被烟草、酒精和槟榔的使用所掩盖。我们在一项大型回顾性台湾OPSCC队列研究中调查了高危型HPV（hrHPV）的作用。1998-2016年在长庚纪念医院接受治疗的541例OPSCC队列包括507例男性（94%）和34例女性（6%）。大多数人使用烟草（81%）、酒精（51%）和槟榔（65%）。使用福尔马林固定的石蜡包埋组织进行p16染色（HPV的替代标志物），并通过多重HPV PCR-MassArray检测HPV DNA的存在和类型。28.4%（150/528）的肿瘤中发现HPV DNA和/或p16染色（HPV阳性）。p16与HPVDNA高度相关（F < 0.0001）。HPV阳性肿瘤中HPV 16阳性率为82.8%，HPV 58阳性率为7.5%。HPV与年龄相关（55.5 vs. 52.7岁，p = 0.004），T分期较低（p = 0.008）总生存期（OS）更好（风险比[HR] 0.58 [95%CI 0.42-0.81]，p = 0.001）和无病生存期（DFS）（HR 0.54 [95%CI 0.40-0.73]，p < 0.0001）。酒精与复发和死亡密切相关（OS：HR 2.06 [95% CI 1.54-2.74]，p < 0.0001; DFS：HR 1.72 [95% CI 1.33-2.24]，p < 0.0001）。饮酒者HPV阳性病例的OS和DFS降低（p < 0.0001）。由于强烈的酒精效应，没有发现烟草或槟榔的预测关联。与全球HPV阳性OPSCC一样，HPV是台湾OPSCC中越来越重要的病因。HPV阳性的OPSCC有相当大的生存益处，但这会因饮酒、吸烟和槟榔而减少。hrHPV是男性和女性的癌症风险因素。在台湾，用包括HPV 58在内的多价疫苗接种两性，结合戒酒和戒烟政策将是有效的癌症预防公共卫生策略。
Human papillomavirus (HPV)-driven oropharyngeal squamous cell carcinoma (OPSCC) is increasing globally. In Taiwan, HPV-positive OPSCC is obscured by tobacco, alcohol, and betel quid use. We investigated the role of high-risk HPV (hrHPV) in a large retrospective Taiwan OPSCC cohort. The cohort of 541 OPSCCs treated at Chang Gung Memorial Hospital from 1998–2016 consisted of 507 men (94%) and 34 women (6%). Most used tobacco (81%), alcohol (51%), and betel quid (65%). Formalin-fixed, paraffin-embedded tissue was used for p16 staining (a surrogate marker for HPV) and testing for HPV DNA presence and type by Multiplex HPV PCR-MassArray. HPV DNA and/or p16 staining (HPV-positive) was found in 28.4% (150/528) tumors. p16 and HPV DNA were strongly correlated (F < 0.0001). HPV16 was present in 82.8%, and HPV58 in 7.5% of HPV-positive tumors. HPV was associated with higher age (55.5 vs. 52.7 years, p = 0.004), lower T-stage (p = 0.008) better overall survival (OS) (hazard ratio [HR] 0.58 [95% CI 0.42–0.81], p = 0.001), and disease-free survival (DFS) (HR 0.54 [95% CI 0.40–0.73], p < 0.0001). Alcohol was strongly associated with recurrence and death (OS: HR 2.06 [95% CI 1.54–2.74], p < 0.0001; DFS: HR 1.72 [95% CI 1.33–2.24], p < 0.0001). OS and DFS in HPV-positive cases decreased for alcohol users (p < 0.0001). Obscured by the strong alcohol effect, predictive associations were not found for tobacco or betel quid. As with HPV-positive OPSCC globally, HPV is an increasingly important etiological factor in Taiwanese OPSCC. HPV-positive OPSCC has considerable survival benefit, but this is reduced by alcohol, tobacco, and betel quid use. hrHPV is a cancer risk factor in males and females. Vaccinating both sexes with a multivalent vaccine including HPV58, combined with alcohol and tobacco cessation policies will be effective cancer-prevention public health strategies in Taiwan.
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