人乳头状瘤病毒相关口咽鳞状细胞癌的特点及临床分析

Characteristics and clinical analysis of human papillomavirus-related oropharyngeal squamous cell carcinoma

目的分析人乳头状瘤病毒(HPV)相关口咽鳞状细胞癌(OPSCC)的临床特点,探讨不同治疗方案对OPSCC患者生活质量的影响,以期更好地指导制定临床治疗方案并判断预后。方法收集2014年1月-2019年1月在北京友谊医院诊治的38例OPSCC患者临床资料,男31例,女7例;其中扁桃体癌24例、舌根癌14例;HPV阳性患者13例,阴性患者25例;Ⅰ、Ⅱ期患者10例,Ⅲ、Ⅳ期患者28例。38例患者中行同步放化疗4例,单纯根治性放疗2例,手术加术后放疗或放化疗27例,诱导化疗+术前放疗+手术或术后补充放疗5例。采用χ;检验分析HPV感染的临床特点,采用Kaplan-Meier法、Log-rank单因素分析和Cox回归模型多因素分析法计算生存率和预后相关因素分析;非参数秩和检验进行生活质量分析。结果在OPSCC患者中,非吸烟、饮酒患者HPV阳性率更高(P=0.014,P=0.049),HPV相关OPSCC患者更易发生颈部淋巴结转移(P=0.032)。HPV阳性以及肿瘤分期Ⅰ、Ⅱ患者总生存率更高(P=0.003,P=0.006),且为影响患者预后的独立危险因素。3种治疗方案患者总生存率差异无统计学意义(P>0.05),但同步放化疗患者吞咽功能障碍更显著,差异存在统计学意义(P=0.002)。结论 HPV相关OPSCC患者中多为非吸烟、饮酒的人群,更容易发生颈部淋巴结转移,但预后相对较好。可考虑降级治疗以保护患者的吞咽功能,改善治疗后的生活质量。

Objective To analyze the clinical characteristics, survival rate and prognosis of human papillomavirus(HPV)-related oropharyngeal squamous cell carcinoma(OPSCC), and to explore the impact of different treatment options on patients’ quality of life, so as to make better treatment plan and estimate the prognosis.Methods Clinical data of 38 patients with HPV-related OPSCC diagnosed and treated in Beijing Friendship Hospital from Jan 2014 to Jan 2019 were collected. There were 31 males and 7 females. The OPSCC included tonsil cancer 24 cases, tongue base cancer 14 cases. Of them, 13 cases were HPV positive and 25 were negative. As for the clinical stage, 10 cases were stage Ⅰ ~ Ⅱ and 28 were stage Ⅲ~ Ⅳ. Six cases were treated with concurrent chemoradiotherapy or radiotherapy alone, 27 with surgery plus postoperative chemoradiotherapy/radiotherapy, and 5 with induction chemotherapy plus radiotherapy and surgery or postoperative supplementary radiotherapy. The clinical characteristics of HPV infection were analyzed by chi-square test. The survival rate and prognostic factors were calculated by Kaplan-Meier method, log-rank univariate analysis and Cox regression model multivariate analysis. The quality of life was analyzed by the non-parametric rank sum test.Results Among all the patients, those with neither smoking nor drinking had higher HPV positive rates(P=0.014, P=0.049), and those with positive HPV were more likely to have cervical lymph node metastasis(P=0.032). The overall survival rates of patients with positive HPV and tumor stage Ⅰ-Ⅱ were higher(P=0.003,P=0.006), which were independent risk factors affecting the prognosis of patients. There were no statistical differences among the overall survival rate of patients treated with the three above-mentioned treatment protocols. However, the patients with concurrent chemoradiotherapy had more significant swallowing dysfunction and the difference was statistically significant(P=0.002).Conclusions Most of the HPV positive OPSCC patients are non-smoking, non-drinking and more likely to have cervical lymph node metastasis, but the prognosis is relatively good. Therefore, treatment de-escalation should be considered to protect the swallowing function and improve the quality of life after treatment.