Prognostic implications of human papillomavirus status for patients with non-oropharyngeal head and neck squamous cell carcinomas
Prognostic implications of human papillomavirus status for patients with non-oropharyngeal head and neck squamous cell carcinomas
复制标题
DOI：
10.1007/s00432-017-2481-8
复制
发表时间：
2017-11-01
影响因子：
3.6
通讯作者：
Witek, Matthew E.
中科院分区：
文献类型：
--
作者：
Ko, Huaising C.;Harari, Paul M.;Witek, Matthew E.
我们研究了一大批人乳头瘤病毒（HPV）阳性和HPV阴性的头颈部非口咽鳞状细胞癌（non-OPSCC）患者的总生存率。在国家癌症数据库（NCDB）中确定了诊断为非opscc和已知HPV状态的患者。应用多因素logistic回归分析与HPV状态相关的因素。采用多变量分析确定与总生存率相关的因素。使用倾向评分加权Kaplan-Meier估计来调整生存分析中的混杂因素。灵敏度分析采用多重输入法。我们确定了19,993例非opscc患者，其中5070例在NCDB中呈HPV阳性。中位随访时间为23.5个月。hpv阳性患者多为男性，白人，合并症指数评分较低，t期< 2，n期为ae1。hpv阴性和hpv阳性患者未经调整的3年总生存率分别为62%和80% （p < 0.0001）。在多变量分析中，hpv阳性患者早期（HR = 0.68）和局部晚期（HR = 0.46）的死亡率降低。hpv阴性患者调整后的3年总生存率为65%，hpv阳性患者为76% （p < 0.0001）。HPV的生存优势在所有亚位点都保持，并且在敏感性分析上是稳健的。hpv阳性的非OPSCC患者表现出与hpv阳性的OPSCC相似的特征。hpv阳性的非opscc患者的总生存率明显高于hpv阴性的非opscc患者。这些数据表明，hpv阳性的非opscc代表了一个有利的队列，值得在未来临床试验研究的设计中得到认可。
We examined overall survival in a large cohort of patients with human papillomavirus (HPV)-positive and HPV-negative non-oropharyngeal squamous cell carcinoma of the head and neck (non-OPSCC).Patients diagnosed with non-OPSCC and known HPV status were identified in the National Cancer Database (NCDB). Multivariate logistic regression was applied to examine factors associated with HPV status. Multivariate analysis was utilized to determine factors correlated with overall survival. Propensity score-weighted Kaplan-Meier estimation was used to adjust for confounders in survival analyses. Multiple imputation method was used for sensitivity analysis.We identified 19,993 non-OPSCC patients with 5070 being positive for HPV in the NCDB. Median follow-up was 23.5 months. HPV-positive patients were more commonly male, white, with a lower comorbidity index score, presenting with T-stage < 2, and N-stage ae1. Unadjusted 3-year overall survival was 62% and 80% for HPV-negative and HPV-positive patients, respectively (p < 0.0001). On multivariate analysis, mortality was reduced for HPV-positive patients with early stage (HR = 0.68) and locally advanced disease (HR = 0.46). Adjusted 3-year overall survival was 65% for HPV-negative and 76% for HPV-positive patients (p < 0.0001). The survival advantage of HPV was maintained in all subsites and robust on sensitivity analysis.Patients with HPV-positive non-OPSCC exhibit similar characteristics as HPV-positive OPSCC. Overall survival was significantly higher for patients with HPV-positive versus HPV-negative non-OPSCC. These data reveal that HPV-positive non-OPSCC represent a favorable cohort that warrants recognition in the design of future clinical trial investigation.