高危型人乳头瘤病毒感染对食管癌术后淋巴结转移和远期预后的影响

Effect of high-risk human papilloma virus infection on lymph node metastasis and long-term prognosis in postoperative esophageal cancer

[目的]探讨高危型人乳头瘤病毒(HPV)感染对食管癌术后淋巴结转移和远期预后的影响。[方法]采用t检验或χ^(2)检验比较HPV阳性和HPV阴性患者一般临床病理资料,采用Cox多因素分析评价高危型HPV感染对食管癌术后淋巴结转移和远期预后的影响,Kaplan-Meier生存分析比较患者食管癌术后5年无淋巴结转移生存率、无病生存率和总生存率。[结果]纳入192例食管癌患者,所有患者均接受手术治疗,平均年龄(56.1±10.7)岁,其中男107例(55.7%),女85例(44.3%),食管癌术后5年发生局部淋巴结转移率、肿瘤复发转移率和全因死亡率分别为23.5%、51.2%和38.9%,按术后食管癌组织免疫组化检查是否感染高危型HPV分为HPV阳性组(58例,30.2%)和HPV阴性组(134例,69.8%),2组患者TNM分期、肿瘤直径和病变伴有溃疡比较差异有统计学意义,Cox多因素分析结果显示,HPV阳性组食管癌患者术后发生局部淋巴结转移的风险是HPV阴性组的3.497倍(HR:3.497,95%CI:2.877~3.922,P=0.011),HPV阳性组食管癌患者术后发生肿瘤复发转移的风险是HPV阴性组的3.497倍(HR:3.856,95%CI:3.223~4.317,P=0.023),HPV阳性组食管癌患者术后死亡的风险是HPV阴性组的4.167倍(HR:4.167,95%CI:3.586~4.614,P=0.026),Kaplan-Meier生存分析显示,HPV阴性组食管癌术后1年、3年、5年无淋巴结转移生存率明显高于HPV阳性组(100%、90.8%、83.2%∶81.2%、67.5%、62.5%,P<0.05),HPV阴性组食管癌术后1年、3年、5年无病生存率明显高于HPV阳性组(100%、72.4%、58.6%∶82.6%、43.6%、37.2%,P<0.05),HPV阴性组食管癌术后1年、3年、5年总生存率明显高于HPV阳性组(100%、84.3%、72.4%∶96.5%、67.2%、58.6%,P<0.05)。[结论]高危型HPV感染显著增加食管鳞癌患者根治术后发生局部淋巴结转移,肿瘤复发转移以及全因死亡的风险。

[Objective]To investigate the effect of high-risk human papilloma virus(HPV)infection on lymph node metastasis and long-term prognosis in postoperative esophageal cancer.[Methods]The general clinical and pathological data between HPV positive group and HPV negative group were compared by t test or χ^(2)test.Cox multivariate analysis was used to evaluate the impact of high-risk HPV infection on postoperative lymph node metastasis and long-term prognosis in esophageal cancer.Kaplan Meier survival analysis was used to compare the 5-year lymph node metastasis free survival rate,disease-free survival rate and overall survival rate of postoperative esophageal cancer between the two groups.[Results]A total of 192 patients with esophageal cancer were enrolled in this study.All patients received surgical treatment,and the average age was(56.1±10.7)year.There were 107 males(55.7%)and 85 females(44.3%).The local lymph node metastasis rate,tumor recurrence and metastasis rate and all-cause mortality rate were 23.5%,51.2%and 38.9%,respectively.According to whether the patients were infected with high-risk HPV detected by immunohistochemistry,they were divided into HPV positive group(58 cases,30.2%)and HPV negative group(134 cases,69.8%).There were significant differences in TNM stage,tumor diameter and ulcer between the two groups.Cox multivariate analysis showed that the risk of local lymph node metastasis in postoperative esophageal cancer patients with high-risk HPV infection was 3.497 times higher than that without high-risk HPV infection(HR:3.497,95%CI:2.877-3.922,P=0.011),the risk of postoperative recurrence and metastasis in postoperative esophageal cancer patients with high-risk HPV infection was 3.497 times higher than that without high-risk HPV infection(HR:3.856,95%CI:3.223-4.317,P=0.023),and the risk of postoperative death in postoperative esophageal cancer patients with high-risk HPV infection was 4.167 times higher than that without high-risk HPV infection(HR:4.167,95%CI:3.586-4.614,P=0.026).Kaplan Meier survival analysis showed that 1-year,3-year,5-year lymph node metastasis free survival rates with high-risk HPV infection were significantly higher than those without HPV infection patients(100%,90.8%,83.2%vs 81.2%,67.5%,62.5%,P<0.05).One-year,3-year,5-year disease free survival rates in high-risk HPV infection patients were significantly higher than those without HPV infection patients(100%,72.4%,58.6%vs 82.6%,43.6%,37.2%,P<0.05).One-year,3-year,5-year overall survival rate in HPV infection patients was significantly higher than that in without HPV infection patients(100%,84.3%,72.4%vs 96.5%,67.2%,58.6%,P<0.05).[Conclusion]High risk HPV infection significantly increases the risk of local lymph node metastasis,tumor recurrence metastasis and all-cause death of esophageal cancer patients after radical resection.