人乳头状瘤病毒感染与国内喉鳞状细胞癌相关性的Meta分析

Metaanalysis on the correlation between human papillomavirus infection and domestic laryngeal squamous cell carcinoma

摘要:

目的为了综合评价国内喉鳞状细胞癌(LSCC)患者中人乳头状瘤病毒(HPV)阳性表达的流行现状。方法利用计算机全面、系统地检索各数据库，根据纳入及排除标准收集文献，应用Stata 14.0统计学软件对所提取的数据进行Meta分析,对收集的数据总体情况进行分析，并以地域因素、患者性别、HPV分型（高危型和低危型）、吸烟史、饮酒史、癌症临床特征（分化程度、原发部位及癌症分期）进行亚组分析，采用Revman 5.3统计学软件对亚组分析的结果进行统计学检验，最终得到国内喉癌患者HPV感染情况。结果共纳入13篇文献，国内喉癌患者中HPV总阳性率为12％（95％CI：9％～15％）；亚组分析结果：国内喉癌患者中高危型HPV阳性率［10％（95％CI：7％～13％）］较低危型HPV阳性率［3％（95％CI：1％～4％）］高，组间差异具有统计学意义（P<0.00 001）；无吸烟史的喉癌患者HPV阳性率［19％（95％CI：12％～26％）］较有吸烟史喉癌患者HPV阳性率［7％（95％CI：2％～12％）］高，差异具有统计学意义（P=0.004）；无饮酒史的喉癌患者HPV阳性率［12％（95％CI：9％～16％）］较有饮酒史的喉癌患者HPV阳性率［5％（95％CI：3％～8％）］高，差异具有统计学意义（P=0.001）。北方喉癌患者中HPV阳性率［12％（95％CI：7％～17％）］与南方喉癌患者HPV阳性率［13％（95％CI：9％～17％）］、女性喉癌患者HPV阳性率［26％（95％CI：3％～55％）］与男性喉癌患者HPV阳性率［11％（95％CI：7％～15％）］、中低分化的喉癌患者HPV阳性率［15％（95％CI：8％～21％）］与高分化的喉癌患者HPV阳性率［9％（95％CI：6％～13％）］、声门型喉癌的HPV阳性率［10％（95％CI：6％～13％）］与非声门型喉癌患者HPV阳性率［13％（95％CI：7％～19％）］、Ⅰ、Ⅱ期喉癌患者的HPV阳性率［16％（95％CI：10％～21％）］与Ⅲ、Ⅳ期喉癌患者的HPV阳性率［17％（95％CI：10％～25％）］对亚组间差异的检验结果显示无明显统计学意义。结论本研究通过对全国喉癌患者HPV阳性率进行Meta分析，进一步明确了HPV与喉癌患者基本特征之间的关系。国内喉癌患者中存在较低的HPV阳性表达，其中高危型HPV阳性率较低危型高，无吸烟史或饮酒史的喉癌患者HPV阳性率更高。此研究结果对了解国内喉癌发生危险因素的分析有一定的参考价值，可用来指导HPV阳性喉癌患者的个体化治疗方案。

关键词:喉鳞状细胞癌|喉癌|人乳头状瘤病毒|Meta分析

Abstract:

ObjectiveTo comprehensively evaluate the prevalence of human papillomavirus (HPV) positive expression in domestic patients with laryngeal squamous cell carcinoma (LSCC).MethodsA comprehensive and systematic search of available databases was performed using a computer, including collection of documents based on inclusion and exclusion criteria, and metaanalysis of the extracted data using Stata14.0 statistical software. The overall data collected were analyzed with subgroup analysis of regional factors, patient gender, HPV classification (high risk and low risk), smoking history, drinking history, clinical features of cancer (differentiation, primary site and clinical stage of cancer), and the results of subgroup analysis were analyzed using Revman 5.3 statistical software to obtain the prevalence of HPV infection in domestic LSCC patients.ResultsA total of 13 articles were included. The total positive rate of HPV in domestic LSCC patients was 12% (95%CI:9% to 15%). Subgroup analyses showed that positive rate of medium to high risk HPV ［10％(95％CI:7％～13％)］ was higher than that of low risk HPV ［3％(95％CI:1％～4％)］, and the difference was statistically significant (P<0.00 001). Furthermore, HPV positive rates in LSCC patients without smoking history ［19%(95% CI:12％～26％)］ or drinking history ［12% (95% CI:9% to 16%)］ were higher than those with smoking history ［7％(95％CI:2％～12％)］ or drinking history ［5％(95％CI:3％～8％)］, respectively, and both the differences were statistically significant (P=0.004;P=0.001). Subgroup analyses also demonstrated that the differences of HPV positive rates between LSCC patients in north ［12％(95％CI:7％～17％)］ and south China ［13％(95％CI:9％～17％)］, female ［26％(95％CI:3％～55％)］ and male ones ［11％(95％CI:7％～15％)］, medium to poor differentiation ［15％(95％CI:8％～21％)］ and high differentiation ［9％(95％CI:6％～13％)］, glottic type ［10％(95％CI:6％～13％)］ and nonglottic type ［13％(95％CI:7％～19％)］, stage Ⅰ/Ⅱ ［16％(95％CI:10％～21％)］ and stage Ⅲ/Ⅳ ［17％(95％CI:10％～25％)］ were all statistically insignificant (all P>0.05).ConclusionsThis metaanalysis furtherly clarifiearess the relationship between HPV and the basic characteristics of LSCC patients in China. The HPV expression rate in domestic LSCC patients is low, the positive rate of highrisk HPV is higher than that of lowrisk type, and HPV positive rates in LSCC patients without smoking history or drinking history are higher than those with smoking history or drinking history. The abovementioned results have certain reference value for understanding risk factors for LSCC in China, and can be used to guide individualized treatment for LSCC patients with positive HPV.

Key words:Laryngeal squamous cell carcinoma| Laryngeal carcinoma| Human papillomavirus| Metaanalysis