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首页> 外文期刊>JAMA otolaryngology-- head & neck surgery >Prognostic significance of p16 and its relationship with human papillomavirus in pharyngeal squamous cell carcinomas
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Prognostic significance of p16 and its relationship with human papillomavirus in pharyngeal squamous cell carcinomas

机译：p16在咽鳞状细胞癌中的预后意义及其与人乳头瘤病毒的关系

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IMPORTANCE: The prognostic significance of p16 in squamous cell carcinoma (SCC) of the hypopharynx (HP) and nasopharynx (NP) and relationship between human papillomavirus (HPV) and p16 is unclear. OBJECTIVES: To evaluate the prognostic significance of p16 in pharyngeal subsites (oropharynx [OP], HP, and NP) and assess the relationship between HPV and p16 in the HP and NP. DESIGN, SETTING, AND PARTICIPANTS: Retrospective medical record review of 172 patients with SCC of the pharynx treated with definitive radiation therapy from 2002 to 2013 at a university tertiary referral center, with tissue available for immunohistochemical analysis. The median follow-up was 30.1 months. INTERVENTIONS: A total of 118 patients were treated with chemoradiation, and 54 patients were treated with radiation alone. Immunohistochemical analysis for p16 was performed for all tumors. Hypopharynx and NP tumors were tested for HPV using in situ hybridization, and NP tumors were tested for Epstein-Barr virus. MAIN OUTCOMES AND MEASURES: Overall survival, locoregional control, and disease-free survival were analyzed according to p16, HPV, and Epstein-Barr virus status. RESULTS: Thirty-two patients had HP SCC, 127 had OP SCC, and 13 had NP SCC. p16 Was positive in the HP (34%), OP (66%), and NP (46%). Prevalence of HPV was 14% in the HP and 50% in the NP. As a test for HPV, p16 had a positive predictive value of 38% (HP) and 67% (NP) and a negative predictive value of 100% in HP and NP tumors. p16 Status was a significant predictor of all clinical outcomes for patients with OP SCC (P<.001), but not for patients with HP or NP SCC. Patients with Epstein-Barr virus- or HPV-associated NP SCC had improved clinical outcomes. CONCLUSIONS AND RELEVANCE: p16 Was not associated with improved outcomes in patients with HP or NP SCC. The positive predictive value of p16 as a test for HPV is too low for p16 testing alone in the HP and NP. However, p16 negativity is sufficient to rule out HPV. As a research approach, we recommend p16 immunohistochemistry as a screening test for HPV in NP SCC and HP SCC followed by confirmatory HPV in situ hybridization when p16 positive.
机译：重要提示：目前尚不清楚p16在下咽（HP）和鼻咽（NP）的鳞状细胞癌（SCC）中的预后意义以及人乳头瘤病毒（HPV）和p16之间的关系。目的：评估p16在咽部亚位（口咽[OP]，HP和NP）中的预后意义，并评估HPV和p16在HP和NP中的关系。设计，地点和参与者：2002年至2013年在大学三级转诊中心对接受明确放射治疗的172例咽部SCC患者进行回顾性病历审查，并提供了可用于免疫组织化学分析的组织。中位随访时间为30.1个月。干预措施：共有118例患者接受了化学放射治疗，而54例患者接受了单独的放射治疗。对所有肿瘤均进行了p16的免疫组织化学分析。使用原位杂交检测下咽和NP肿瘤的HPV，并且检测NP肿瘤的爱泼斯坦-巴尔病毒。主要结果和措施：根据p16，HPV和Epstein-Barr病毒状况分析了总生存期，局部区域控制和无病生存期。结果：HP SCC患者32例，OP SCC患者127例，NP SCC患者13例。 p16在HP（34％），OP（66％）和NP（46％）中呈阳性。 HPV的患病率在HP中为14％，在NP中为50％。作为对HPV的测试，p16在HP和NP肿瘤中的阳性预测值为38％（HP）和67％（NP），阴性预测值为100％。 p16状态是OP SCC患者（P <.001）的所有临床结局的重要预测指标，而HP或NP SCC患者则不是。与爱泼斯坦-巴尔病毒或HPV相关的NP SCC患者的临床结局有所改善。结论和相关性：p16与HP或NP SCC患者的预后改善无关。对于HPV和NP单独进行p16测试，p16作为HPV测试的阳性预测值太低。但是，p16阴性足以排除HPV。作为研究方法，我们建议使用p16免疫组化作为NP SCC和HP SCC中HPV的筛选测试，然后在p16阳性时进行确认性HPV原位杂交。

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