HPV阳性角化型鼻咽癌与更好的生存相关：一项NCDB研究

文献信息

中文摘要

目的： 探讨人乳头瘤病毒（HPV）在鼻咽癌（NPC）中的预后意义。
方法： 使用美国国家癌症数据库（NCDB）查询2010年至2017年间具有可用HPV检测数据的NPC患者。采用逻辑回归预测与HPV检测及HPV阳性相关的因素。使用Kaplan-Meier分析比较HPV阳性与HPV阴性队列之间的总生存期（OS）。采用Cox比例风险模型进行单因素和多因素分析，以评估与OS相关的因素。
结果： 在我们的5081例患者队列中，3177例（62.5%）接受了HPV检测。Kaplan-Meier分析显示，角化型NPC亚型中HPV阳性患者OS改善（log rank p < 0.001）。在其他组织学亚型的NPC患者中未观察到OS差异。在角化型鳞状细胞癌队列的多因素分析中，控制性别、年龄、种族、保险状况、机构规模、机构类型、邮政编码水平教育程度、Charlson合并症评分、分期和治疗后，HPV阳性与更好的OS相关（HR 0.81，95% CI：0.70-0.94，p = 0.006）。
结论： 在角化型NPC亚型患者中，HPV状态与改善的OS独立相关。在NPC的检查中纳入HPV检测可能是合理的。

英文摘要

OBJECTIVES: To investigate the prognostic relevance of human papillomavirus (HPV) in nasopharyngeal carcinoma (NPC).
METHODS: The National Cancer Data Base (NCDB) was used to query patients with NPC and available HPV testing data between 2010 and 2017. Logistic regression was performed to predict factors associated with HPV testing and HPV positivity. Overall survival (OS) was evaluated using Kaplan Meier analysis between HPV-positive versus HPV-negative cohorts. Univariate and multivariate analyses using Cox proportional hazards modeling were performed to assess for factors associated with OS.
RESULTS: Among our cohort of 5081 patients, 3177 (62.5%) underwent HPV testing. Kaplan Meier analysis revealed improved OS among HPV-positive patients with keratinizing subtype of NPC (log rank p < 0.001). No differences in OS were observed in patients with other histologic subtypes of NPC. On multivariate analysis of the keratinizing SCC cohort, HPV positivity was associated better OS after controlling for sex, age, race, insurance status, facility volume, facility type, zip code level education, Charlson comorbidity score, staging, and treatment (HR 0.81, 95% CI: 0.70-0.94, p = 0.006).
CONCLUSION: HPV status was independently associated with improved OS among patients with keratinizing subtype of NPC. Incorporation of HPV testing may be warranted in the workup of NPC.