口咽部鳞状细胞癌人乳头状瘤病毒感染预后初步分析

Human papillomavirus infection in oropharyngeal squamous cell carcinoma and prognosis： apreliminary analysis of 66 cases

目的分析人乳头状瘤病毒（humanpa pillomavirus，HPV）感染与口咽鳞状细胞癌（简称鳞癌）患者的预后关系。方法回顾性分析1999年1月至2009年12月符合人组条件的口咽鳞癌患者共66例，利用聚合酶链反应方法检测其标本HPV感染状态。Kaplan-Meier法分析患者总体生存率和疾病特异性生存率与HPV感染状态的关系，Cox模型进行多因素分析。结果口咽癌患者HPV总感染率为16．7％（11／66），其中，HPV-16型7例，HPV-16／11、HPV-35、HPV-58／52和HPV-33／52／54型各1例。随访3～78个月，中位时间24．5个月。本组患者3年总体生存率为59．4％，HPV阳性组为90．0％，HPV阴性组为52．4％；3年疾病特异性生存率为63．0％，HPV阳性组为90．0％，HPV阴性组为56．4％，HPV阳性患者两组生存率均明显高于HPV阴性者（X^2分别为5．792和4．721，P值分别为0．016和0．030）。Cox回归分析结果显示，有无HPV感染状态和N分级是影响口咽部鳞癌预后的独立危险因素（P值均〈0．01）。结论口咽部鳞癌患者HPV感染率为16．7％。HPV阳性的口咽鳞癌患者预后优于HPV阴性组患者，有无HPV感染是影响预后的独立危险因素。

Objective To analyze the relationship between the prognosis of patients with oropharyngeal squamous cell carcinoma （OSCC） and human papillomavirus （HPV） infection in OSCC. Methods Sixty-six patients with oropharyngeal carcinoma who met the enrollment criteria during the period from January 1999 to December 2009 were retrospectively reviewed. The presence or absence of HPV oncogenic types in OSCC specimen was determined by multiplex polymerase chain reaction （PCR）. Overall survival （OS） and disease specific survival （DSS） for HPV-positive and HPV-negative patients were estimated by Kaplan-Meier analysis. Cox regression model was used for multivariate analysis. Results HPV-DNA was detected in 11 （ 16. 7% ） of all specimens. Among them, 7 were positive for HPV-16, 1 for HPV-16/ll, 1 for HPV-35, 1 for HPV-58/52, and 1 for HPV-33/52/54. With the follow-up of 3-78 months（a median of 24. 5 months）, patients with HPV-positive tumors had significantly better overall survival（x2 = 5. 792, P = 0. 016） and disease specific survival （X2 = 4. 721, P = 0. 030 ）, the 3-year OS and DSS were 90. 0% vs 52.4% and 90. 0% vs 56.4% , respectively. Multivariate analysis by Cox regression model showed that HPV infection and nodal status were both independent prognostic factors for patients with OSCC （P 〈 0.05）. Conclusions Patients with HPV-positive OSCC have significantly better prognosis than patients with HPV-negative tumors. HPV infection is an independent prognostic factor.