Treatment outcomes in veterans with HPV-positive head and neck cancer
Treatment outcomes in veterans with HPV-positive head and neck cancer
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DOI：
10.1016/j.amjoto.2017.01.005
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发表时间：
2017-03-01
影响因子：
2.5
通讯作者：
Wang, Marilene B.
中科院分区：
文献类型：
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作者：
Feinstein, Aaron J.;Shay, Sophie G.;Wang, Marilene B.
目的：由人乳头瘤病毒（HPV）引起的头颈部鳞状细胞癌（HNSCC）相对于HPV阴性肿瘤具有更好的预后。hpv阳性疾病患者可能受益于不同的治疗方式，以优化生存和生活质量。我们试图调查退伍军人人群中hpv阳性的HNSCC，并分析治疗方式在hpv阳性和hpv阴性肿瘤患者预后中的作用。方法：对2010年1月1日至2014年12月31日在某地区退伍军人保健中心诊断为HNSCC的患者进行回顾性分析。病理标本进行HPV亚型和p16表达检测。分析了人口统计学和临床因素，包括治疗方式对总生存期主要结局的影响。结果：209例患者原发肿瘤部位包括喉（25.4%）、口舌（19.6%）、口腔（13.4%）、口咽（17.2%）、扁桃体（17.2%）、原发不明（2.9%）、鼻咽（1.9%）、多部位（2.4%）。患者有HPV阳性（n = 82, 392%）、HPV阴性（ri = 89, 42.6%）或未知HPV状态（n = 38, 18.2%）。主要治疗方式为放化疗（n = 124, 59.3%）、手术（n = 39, 18.7%）、放疗（n = 37, 17.7%）或不治疗（n = 9, 4.3%）。Cox比例风险模型的生存分析显示，与T分型（T4 3.61, P = 0.005）、N分型（N3 3.52, P = 0.0159）、M分型（Ml 2.8, P = 0.0209）和HPV状态（HPV阳性0.43,P = 0.0185）相关，但与初次治疗方式无关（初次手术vs初次放化疗1.01,P = 0.9718）。结论：与分期相似的hpv阴性患者相比，退伍军人人群中hpv阳性HNSCC的预后明显改善。这项研究表明，主要的治疗方式——放化疗、放疗或手术——对患有丙型肝炎阳性HNSCC的退伍军人的总生存率没有影响。
Objectives: Head and neck squamous cell carcinoma (HNSCC) caused by the human papilloma virus (HPV) has an improved prognosis relative to HPV-negative tumors. Patients with HPV-positive disease may benefit from different treatment modalities in order to optimize survival and quality of life. We sought to investigate HPV-positive HNSCC within the military veteran population, and analyze the role of treatment modality in outcomes of patients with HPV-positive and HPV-negative tumors.Methods: Patients diagnosed with HNSCC between January 1, 2010 and December 31, 2014 at one regional veterans health center were retrospectively examined. Pathologic specimens underwent testing for HPV subtype and p16 expression. Demographic and clinical factors, including treatment modality, were analyzed for their impact on the primary outcome of overall survival.Results: There were 209 patients with primary tumor sites including larynx (25.4%), oral tongue (19.6%), oral cavity (13.4%), oropharynx (17.2%), tonsil (17.2%), unknown primary (2.9%), nasopharynx (1.9%), and multiple sites (2.4%). Patients had HPV-positive (n = 82, 392%), HPV-negative (ri = 89, 42.6%) or unknown HPV status (n = 38, 18.2%). Primary treatment modalities were chemoradiation (n = 124, 59.3%), surgery (n = 39, 18.7%), radiation therapy (n = 37, 17.7%), or no treatment (n = 9, 4.3%). Survival analysis with Cox proportional hazards model demonstrated significant associations with T classification (T4 3.61, P = 0.005), N classification (N3 3.52, P = 0.0159), M classification (Ml 2.8, P = 0.0209), and HPV status (HPV-positive 0.43, P = 0.0185), but no relation with primary treatment modality (primary surgery vs. primary chemoradiation 1.01, P = 0.9718).Conclusion: HPV-positive HNSCC in the veteran population has a significantly improved prognosis relative to similarly staged patients with HPV-negative disease. This study demonstrates that the primary treatment modality- chemoradiation, radiation therapy, or surgery- does not impact overall survival among veterans with HPVpositive HNSCC.