Human Papillomavirus as a Marker of the Natural History and Response to Therapy of Head and Neck Squamous Cell Carcinoma
Human Papillomavirus as a Marker of the Natural History and Response to Therapy of Head and Neck Squamous Cell Carcinoma
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DOI：
10.1016/j.semradonc.2011.12.004
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发表时间：
2012-04-01
影响因子：
3.5
通讯作者：
Sturgis, Erich M.
中科院分区：
文献类型：
--
作者：
Ang, Kie Kian;Sturgis, Erich M.
头颈部癌的人口统计学发生了逐渐的变化。虽然相对罕见，口咽癌的发病率一直在增加，尽管烟草消费量下降，相反，在其他头部和颈部部位的癌症发病率下降。现在很清楚，人乳头瘤病毒（HPV）相关口咽癌的发病率正在上升，这可能是生活方式和性行为改变的结果。许多研究有助于了解HPV相关口咽癌的特征，其通常表现为低至中等T分类的非角化鳞状细胞癌，影响中年白色男性，具有较高的社会经济地位，没有或有短暂的烟草消费史。这种独特的肿瘤实体的诊断可以牢固地建立了p16免疫组化和原位杂交检测相结合。与传统的吸烟相关的头颈部鳞状细胞癌相比，HPV相关的口咽癌具有良好的自然史，对治疗的反应更好。因此，患有这种癌症的患者比患有HPV无关的头颈部鳞状细胞癌的患者具有更好的长期生存率（例如，5年总生存率>80%，而III-IV期肿瘤患者的5年总生存率为40%），因此他们更可能经历慢性治疗诱导的发病率。因此，需要对该患者组进行评估、分期和治疗方面的改变。然而，改变HPV相关口咽癌治疗的尝试应该在密切监测的临床试验环境中进行。在这篇文章中，我们总结了HPV相关口咽癌的流行病学，诊断和临床行为，重点是预后和生物标志物的发现方面，并简要讨论了目前的想法，改变治疗模式，旨在降低发病率，同时通过协调良好的前瞻性试验，保持高肿瘤控制概率。Semin Radiat Oncol 22：128-142（c）2012 Elsevier Inc. All rights reserved.
There has been a gradual change in the demographics of head and neck carcinoma. Although relatively uncommon, the incidence of oropharyngeal carcinoma has been increasing despite declining tobacco consumption and contrary to a diminishing incidence of cancers at other head and neck sites. It is now clear that the incidence of human papillomavirus (HPV)-associated oropharyngeal cancers is rising, likely as a consequence of changing life styles and sexual behaviors. Many studies have contributed to understanding the characteristics of HPV-related oropharyngeal carcinoma, which usually presents as nonkeratinizing squamous cell carcinoma of low to intermediate T-category and affects middle-aged white men, having higher socioeconomic status and no or brief history of tobacco consumption. The diagnosis of this distinct neoplastic entity can be firmly established by a combination of p16 immunohistochemical and in situ hybridization assays. Compared with the traditional smoking-associated head and neck squamous cell carcinoma, HPV-related oropharyngeal carcinoma has a favorable natural history and responds better to treatment. Consequently, patients with this cancer have better long-term survival than those with HPV-unrelated head and neck squamous cell carcinoma (eg, 5-year overall survival rate of >80% versus similar to 40% for patients with stage III-IV tumors), and hence they are more likely to experience chronic therapy-induced morbidity. Therefore, changes in evaluation, staging, and treatment are needed for this patient group. However, attempts to change the treatment for HPV-associated oropharyngeal carcinoma should take place in a closely monitored clinical trial setting. In this article, we summarize the epidemiology, diagnosis, and clinical behavior of HPV-associated oropharyngeal carcinoma, with emphasis on prognostic and biomarker discovery aspects, and discuss briefly the current thoughts on changing the treatment paradigms aimed at reducing morbidity while preserving the high tumor control probability through well-coordinated prospective trials. Semin Radiat Oncol 22:128-142 (c) 2012 Elsevier Inc. All rights reserved.