关键词: 口咽鳞癌, HPV, P16免疫组织化学检测, HPV-RNA PCR检测, 咽脱落细胞检测, TNM 分期, 生存率

Abstract: PURPOSE: To compare the detection rate of human papillomavirus (HIV) associated oropharyngeal squamous cell carcinoma (SCC) with 3 methods, including brush cytology of oropharynx, P16 immunohistochemistry (IHC) and HPV polymerase chain reaction (PCR), evaluate the prognosis of patients with HPV positive based on the new and old TNM staging system, in order to provide clinical evidence to guide the precise diagnosis and treatment of HPV-related oropharyngeal SCC. METHODS: The results of brush cytology, P16 IHC and PCR in 171 patients with oropharyngeal SCC were analyzed and compared. The clinical and pathological data of 68 patients with HPV associated oropharyngeal SCC were collected,according to the new and old TNM staging system, the degradation situation was determined, the survival rate of patients at each stage, and the prognosis of patients with the new and old TNM stages was analyzed with SPSS 22.0 software package. RESULTS: The positive rates of HPV detected by P16 IHC, brush cytology and PCR were 25.7%, 14.6% and 24.0%, respectively. There was significant difference between brush cytology and other two methods (P =0.000), but there was no significant difference between IHC and PCR (P=0.205). Sixty-eight patients with HPV positive oropharyngeal SCC were classified according to the 7th and 8th edition of TNM staging system, they were 3 and 42 in stage Ⅰ, 7 and 14 in stage Ⅱ, 17 and 9 in stage Ⅲ, and 41 and 3 in stage Ⅳ, respectively. The 3-year survival rates of patients in the 7th and 8th edition of staging system was compared, stage Ⅰ was 100.0% and 89.7%(P=0.672), stage Ⅱ was 68.6% and 61.9% (P=0.961), stage Ⅲ was 66.8% and 37.0% (P=0.043), IV stage was 74.8% and 0.00% (P=0.000), respectively. The survival rates of early stage patients (stagesⅠandⅡ) in the 7th and 8th edition of staging system were 78.8% and 82.7% (P=0.585), and the survival rates of advanced patients (stage Ⅲ and Ⅳ) were 71.2% and 27.8% (P=0.000), respectively. According to the 7th edition of staging system of HPV positive patients, the survival rates of early and late patients were 78.8% and 71.2% (P=0.982). According to the 8th edition of staging system, the survival rates of early and late patients were 82.7% and 27.8%, respectively (P=0.000). CONCLUSIONS: Brush cytology test should not be used as a standard for the diagnosis of HPV positive oropharyngeal SCC. P16 IHC and PCR have their advantages and disadvantages, and should be selected according to the individual situation. For patients with HPV positive oropharyngeal SCC, the new staging system is more consistent with the actual clinical situation, the prognostic stratification is clearer, and it can better guide clinical decision-making and is worthy of clinical application

Key words: Oropharyngeal carcinoma, HPV, P16 IHC, HPV-RNA PCR, Brush cytology, TNM staging, Survival rate