鼻腔鼻窦内翻性乳头状瘤恶变鳞状细胞癌中HPV的分布及预后分析

Distribution of HPV infection and prognostic analysis in patients with squamous cell carcinoma arising from sinonasal inverted papilloma

摘要:

目的检测人类乳头状瘤病毒（ human papillomavirus, HPV）在鼻腔鼻窦内翻性乳头状瘤恶变鳞状细胞癌（squamous cell carcinoma arising from sinonasal inverted papilloma，SCC/IP）中的感染分布，分析两者的预后关系。方法回顾性分析1997年1月~2012年1月符合入组条件的SCC/IP患者共55例，利用“三明治”方法检测其标本HPV的感染状态，采用KaplanMeier生存分析法研究患者总生存率和疾病特异性生存率，采用Logrank检测进行单因素分析，采用Cox模型进行多因素分析，计数资料之间采用卡方检验。结果HPV感染11例，感染比例为20%(11/55)，其中HPV16型5例,HPV6型3例，HPV39型、HPV18/39型和HPV33/52/54型各1例。5年总生存率为35.6%，HPV阳性组为18.7%，HPV阴性组为38.9%；5年疾病特异性生存率为42.7%，HPV阳性组为18.7%，HPV阴性组为49.2%。HPV阳性组总体生存率和疾病特异性生存率与HPV阴性组比较，差异无统计学意义(P=0.915，P=0.773), Cox模型分析示HPV状态对总体生存率及疾病特异性生存率亦无影响（P=0.553， P=0.976）。结论SCC/IP中HPV感染率为20%，HPV感染状态对SCC/IP的预后没有影响。

关键词:内翻性乳头状瘤|鳞状细胞癌|人类乳头状瘤病毒|预后

Abstract:

ObjectiveTo detect the distribution of human papilloma virus (HPV) infection in patients with squamous cell carcinoma arising from sinonasal inverted papilloma (IP/SCC), and to analyze the relationship between the prognosis and HPV infection.Methods55 patients with IP/SCC who met the enrollment criteria during the period from Jan.1997 to Dec.2009 were reviewed retrospectively. A “sandwich” technique was used to cut paraffin sections for hematoxylin and eosin (HE) staining and HPVDNA analysis. Overall survival (OS) and disease specific survival (DSS) for HPVpositive and HPVnegative patients were estimated by KaplanMeier analysis. Univariate and multivariate regression analyses were performed using Logrank and Cox regression model respectively. Counting data were compared via Chisquare test.ResultsHPV infection was detected in 11 specimens with an infection rate of 20%(11/55). As for the HPV subtype, the case number of HPV16 infection was 5(45.5%,5/11), HPV6 was 3(27.3%,3/11),and one(9.1%,1/11) in each of HPV39,HPV18/39 and HPV33/52/54. The 5year OS rate was 35.6%, while those of HPVpositive and HPVnegative patients were 18.7% and 38.9%. The 5year DSS rate was 35.6%, while those of HPVpositive and HPVnegative patients were 18.7% and 49.2%. Both differences of OS rate and DSS rate between HPVpositive patients and HPVnegative patients were statistically insignificant (P=0.915, P=0.773). Cox regression model analysis showed that HPV infection had no influence on OS rate and DSS rate (P=0.553，P=0.976).ConclusionWith an infection rate of 20% in IP/SCC patients, HPV has no impact on the prognosis of IP/SCC.

Key words:Inverted papilloma|Squamous cell carcinoma|Human papilloma virus| Prognosis