68例HPV相关口咽鳞癌患者生存分析

Survival analysis of 68 HPV related oropharyngeal squamous cell carcinoma based on the new clinical staging system

目的:探讨口咽癌HPV适用检测方法并比较HPV阳性患者新、旧版肿瘤TNM分期降级后的预后差异,为指导HPV相关口咽癌的精准诊疗提供临床依据。方法:对171例口咽鳞状细胞癌(简称鳞癌)患者,分别行脱落细胞学、P16免疫组织化学及HPV-RNA PCR检测HPV,比较3种检测方法的结果。分析68例HPV相关口咽鳞癌患者的临床及病理资料,根据新、旧版TNM分期标准对其重新分期,了解降级情况,统计各期患者生存率,比较新、旧2版分期患者的预后,应用Kaplan-Meier方法建模,采用SPSS 22.0软件包进行统计学分析。结果:免疫组织化学P16检测、口咽脱落细胞检测和PCR检测的口咽癌HPV阳性检出率分别为25.7%、14.6%和24.0%,脱落细胞检测与其他2种检测均有统计学差异(P=0.000),免疫组织化学和PCR检测无统计学差异(P=0.205)。68例HPV阳性口咽鳞癌患者按照第7版与第8版TNM标准分期,分别为Ⅰ期3和42例,Ⅱ期7和14例,Ⅲ期17和9例,Ⅳ期41和3例。第7版与8版分期患者3年生存率比较,Ⅰ期100.0%和89.7%(P=0.672),Ⅱ期68.6%和61.9%(P=0.961),Ⅲ期66.8%和37.0%(P=0.043),Ⅳ期74.8%和0.00%(P=0.000)。第7与8版分期的早期患者(Ⅰ、Ⅱ期)生存率比较,78.8%和82.7%(P=0.585),晚期患者(Ⅲ、Ⅳ期)生存率比较,71.2%和27.8%(P=0.000)。HPV阳性患者按照第7版分期,早期与晚期患者生存率为78.8%和71.2%(P=0.982);按照8版分期,早期与晚期患者生存率为82.7%和27.8%(P=0.000)。结论:脱落细胞检查不宜作为诊断HPV阳性口咽鳞癌的单一标准,P16免疫组织化学检测和PCR基因检测各有优缺点,应根据实际情况选择。对于HPV阳性口咽鳞癌患者,新版分期更符合临床实际情况,预后分层更加清晰,能更好指导临床决策,值得临床推广应用。

PURPOSE: To compare the detection rate of human papillomavirus(HIV) associated oropharyngeal squamous cell carcinoma(SCC) with 3 methods, including brush cytology of oropharynx, P16 immunohistochemistry(IHC) and HPV polymerase chain reaction(PCR), evaluate the prognosis of patients with HPV positive based on the new and old TNM staging system, in order to provide clinical evidence to guide the precise diagnosis and treatment of HPV-related oropharyngeal SCC. METHODS: The results of brush cytology, P16 IHC and PCR in 171 patients with oropharyngeal SCC were analyzed and compared. The clinical and pathological data of 68 patients with HPV associated oropharyngeal SCC were collected,according to the new and old TNM staging system, the degradation situation was determined, the survival rate of patients at each stage, and the prognosis of patients with the new and old TNM stages was analyzed with SPSS 22.0 software package. RESULTS: The positive rates of HPV detected by P16 IHC, brush cytology and PCR were25.7%, 14.6% and 24.0%, respectively. There was significant difference between brush cytology and other two methods(P=0.000), but there was no significant difference between IHC and PCR(P=0.205). Sixty-eight patients with HPV positive oropharyngeal SCC were classified according to the 7 th and 8 th edition of TNM staging system, they were 3 and 42 in stage Ⅰ, 7 and 14 in stage Ⅱ, 17 and 9 in stage Ⅲ, and 41 and 3 in stage Ⅳ, respectively. The 3-year survival rates of patients in the 7 th and 8 th edition of staging system was compared, stage Ⅰ was 100.0% and 89.7%(P=0.672), stage Ⅱwas 68.6% and 61.9%(P=0.961), stage Ⅲ was 66.8% and 37.0%(P=0.043), Ⅳ stage was 74.8% and 0.00%(P=0.000),respectively. The survival rates of early stage patients(stagesⅠandⅡ) in the 7 th and 8 th edition of staging system were78.8% and 82.7%(P=0.585), and the survival rates of advanced patients(stage Ⅲ and Ⅳ) were 71.2% and 27.8%(P=0.000), respectively. According to the 7 th edition of staging system of HPV positive patients, the survival rates of early and late patients were 78.8% and 71.2%(P=0.982). According to the 8 th edition of staging system, the survival rates of early and late patients were 82.7% and 27.8%, respectively(P=0.000). CONCLUSIONS: Brush cytology test should not be used as a standard for the diagnosis of HPV positive oropharyngeal SCC. P16 IHC and PCR have their advantages and disadvantages, and should be selected according to the individual situation. For patients with HPV positive oropharyngeal SCC, the new staging system is more consistent with the actual clinical situation, the prognostic stratification is clearer,and it can better guide clinical decision-making and is worthy of clinical application.