Human Papillomavirus and Survival of Patients with Oropharyngeal Cancer

被引:5018
作者
Ang, K. Kian [2 ]
Harris, Jonathan [3 ]
Wheeler, Richard [5 ]
Weber, Randal [2 ]
Rosenthal, David I. [2 ]
Nguyen-Tan, Phuc Felix [6 ]
Westra, William H. [7 ]
Chung, Christine H. [8 ]
Jordan, Richard C. [10 ]
Lu, Charles [2 ]
Kim, Harold [11 ]
Axelrod, Rita [4 ]
Silverman, C. Craig [9 ]
Redmond, Kevin P. [12 ]
Gillison, Maura L. [1 ]
机构
[1] Ohio State Univ, Ctr Comprehens Canc, Columbus, OH 43210 USA
[2] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA
[3] Radiat Therapy Oncol Grp Stat Ctr, Philadelphia, PA USA
[4] Thomas Jefferson Univ Hosp, Philadelphia, PA 19107 USA
[5] Huntsman Canc Inst, Salt Lake City, UT USA
[6] Ctr Hosp Univ Montreal, Montreal, PQ, Canada
[7] Johns Hopkins Univ, Baltimore, MD USA
[8] Vanderbilt Univ, Sch Med, Nashville, TN 37212 USA
[9] Univ Louisville, Louisville, KY 40292 USA
[10] Univ Calif San Francisco, San Francisco, CA 94143 USA
[11] Wayne State Univ, Med Ctr, Detroit, MI 48202 USA
[12] Univ Cincinnati, Coll Med, Cincinnati, OH USA
关键词
SQUAMOUS-CELL CARCINOMA; ONCOLOGY GROUP RTOG; RADIATION-THERAPY; NECK CANCERS; HEAD; RADIOTHERAPY; P16; METAANALYSIS; EXPRESSION; INFECTION;
D O I
10.1056/NEJMoa0912217
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Oropharyngeal squamous-cell carcinomas caused by human papillomavirus (HPV) are associated with favorable survival, but the independent prognostic significance of tumor HPV status remains unknown. METHODS We performed a retrospective analysis of the association between tumor HPV status and survival among patients with stage III or IV oropharyngeal squamous-cell carcinoma who were enrolled in a randomized trial comparing accelerated-fractionation radiotherapy (with acceleration by means of concomitant boost radiotherapy) with standard-fractionation radiotherapy, each combined with cisplatin therapy, in patients with squamous-cell carcinoma of the head and neck. Proportional-hazards models were used to compare the risk of death among patients with HPV-positive cancer and those with HPV-negative cancer. RESULTS The median follow-up period was 4.8 years. The 3-year rate of overall survival was similar in the group receiving accelerated-fractionation radiotherapy and the group receiving standard-fractionation radiotherapy (70.3% vs. 64.3%; P = 0.18; hazard ratio for death with accelerated-fractionation radiotherapy, 0.90; 95% confidence interval [CI], 0.72 to 1.13), as were the rates of high-grade acute and late toxic events. A total of 63.8% of patients with oropharyngeal cancer (206 of 323) had HPV-positive tumors; these patients had better 3-year rates of overall survival (82.4%, vs. 57.1% among patients with HPV-negative tumors; P<0.001 by the log-rank test) and, after adjustment for age, race, tumor and nodal stage, tobacco exposure, and treatment assignment, had a 58% reduction in the risk of death (hazard ratio, 0.42; 95% CI, 0.27 to 0.66). The risk of death significantly increased with each additional packyear of tobacco smoking. Using recursive-partitioning analysis, we classified our patients as having a low, intermediate, or high risk of death on the basis of four factors: HPV status, pack-years of tobacco smoking, tumor stage, and nodal stage. CONCLUSIONS Tumor HPV status is a strong and independent prognostic factor for survival among patients with oropharyngeal cancer. (ClinicalTrials.gov number, NCT00047008.)
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页码:24 / 35
页数:12
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