人乳头状瘤病毒与口咽鳞状细胞癌预后相关性的meta分析  

The relationship between human papillomavirus and prognosis of oropharyngeal squamous cell carcinoma： a meta analysis

作　　者：徐媛媛[1] 洪苏玲[1] 曾泉[1] 钟时勋[1] 杨玉成[1] 康厚墉[1] 胡国华[1] 

机构地区：[1]重庆医科大学附属第一医院耳鼻咽喉科,400016

出　　处：《中华耳鼻咽喉头颈外科杂志》2015年第3期236-243,共8页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家临床重点专科建设项目经费卫办医政函[2012]649号

摘　　要：目的 对人乳头状瘤病毒（human papillomavirus virus,HPV）与口咽鳞状细胞癌（鳞癌）预后关系进行meta分析,为口咽鳞癌的发生发展和防治提供参考依据.方法 计算机检索Pubmed、Embase、Web of science、Medline,检索时间区间均为建库至2014年6月1日.按照事先设置的标准由两位研究者独立进行筛选、提取相关资料并用State11.2软件进行分析,利用随机效应模型的meta分析评价各项研究中HPV阳性与HPV阴性口咽鳞癌患者的各项生存指标.结果 37项共3869例研究纳入本篇meta分析.结果显示,HPV阳性的口咽鳞癌患者的各项生存指标均优于HPV阴性者：前者有更低的死亡风险（HR=0.39,95％ CI0.32 -0.46）,肿瘤复发和进展风险更低,复发和进展风险分别为HR =0.38,95％ CI0.29 -0.47; HR =0.46,95％ CI0.29-0.63,同时,HPV阳性的口咽鳞癌患者的肿瘤局部区域复发率也低于HPV阴性者（HR=0.34,95％ CI0.25 -0.42）.虽然HPV检测方式不尽相同,研究人群的地区也有所差异,但最终均得到类似的结果.结论 HPV阳性口咽鳞癌患者的总生存率和疾病特异性生存率均明显高于HPV阴性口腔鳞癌患者,且有较低水平的复发率.通过对就诊的口咽癌患者常规进行HPV检测,有利于对疾病预后进行更好的判断.Objective To examine survival differences in prognosis and survival between patients with HPV-positive and those with HPV-negative oropharyngeal squamous cell carcinoma （OPSCC）.Methods Pubmed,Embase,Web of science and Medline databases were searched from their inception till June 2014.A random-effect meta-analysis was used to pool study estimates evaluating overall （all-cause mortality）,disease-specific （death from OPSCC）,disease-free （recurrence free）,progression-free survival outcomes and local regional control rate in HPV-positive vs HPV-negative OPSCC.After study selection,two reviewers assessed and extracted data independently.Meta-analysis was performed using the STATA 11.0software.Results Thirty-seven studies were included.HPV-positive OPSCC patients had a better overall survival compared to HPV-negative patients （HR 0.39,95% CI 0.32-0.46）.HPV-positive OPSCC patients had a significantly lower disease specific mortality （HR 0.31,95% CI 0.22-0.39） and were less likely to experience progression or recurrence of their cancers than HPV-negative patients （HR 0.34,95%CI 0.25-0.42）.Both disease-free survival and progression-free survival were significantly improved in patients with HPV-positive OPSCC （HR 0.38,95% CI 0.29-0.47 and HR 0.46,95% CI 0.29-0.63,respectively）.Conclusions HPV infection is an important prognostic factor of OPSCC.Stratified therapies can be applied in OPSCC based on HPV status of tumours.

关 键 词：口咽肿瘤 癌 鳞状细胞 乳头状瘤病毒科 预后 META分析 

分 类 号：R739.6[医药卫生—肿瘤]