Sex-based differences in outcomes of patients with HPV-positive versus HPV-negative oropharyngeal carcinoma: a population-based study

Prior studies have suggested that female sex is predictive of poor outcomes among patients with oropharyngeal carcinoma. The current study aims at elucidating whether this observation applies to both HPV-positive and HPV-negative subsets of the disease. Surveillance, Epidemiology and End Results (SEER) - HPV specialized database was accessed. Cases with oropharyngeal squamous cell carcinoma and known HPV status were reviewed. Multivariable logistic regression analysis was used to evaluate factors predicting HPV positive status. The relationship between sex and overall and cancer-specific survival was further evaluated through multivariable Cox regression analysis. Female sex was associated with less probability of HPV positive status (OR: 0.55; 95% CI: 0.50-0.61; P<0.01). Using multivariable Cox regression analysis and among patients with HPV-negative disease, female patients have worse overall survival (HR: 1.24; 95% CI: 1.12-1.39; P<0.01) and cancer-specific survival (HR: 1.27; 95% CI: 1.08-1.50; P<0.01); while among patients with HPV-positive disease, there was no difference between males and females with regards to overall survival (HR: 1.05; 95% CI: 0.91-1.21; P= 0.45) or cancer-specific survival (HR: 1.17; 95% CI: 0.95-1.45; P= 0.12). Among patients with HPV-positive oropharyngeal carcinoma, there is no difference in survival outcomes between women and men; while among patients with HPV-negative oropharyngeal carcinoma, women have worse survival outcomes compared to men.

既往研究表明，在口咽癌患者中，女性性别是不良预后的预测因素。本研究旨在明确这一观察结论是否适用于该病的HPV阳性（HPV-positive）与HPV阴性（HPV-negative）亚型。本研究调取了监测、流行病学与最终结果（Surveillance, Epidemiology and End Results, SEER）- HPV专用数据库，对HPV状态明确的口咽鳞状细胞癌病例进行了回顾性分析。采用多变量logistic回归分析评估预测HPV阳性状态的相关因素，并通过多变量Cox回归分析进一步评估性别与总生存期、肿瘤特异性生存期之间的关联。研究结果显示，女性患者的HPV阳性概率更低（比值比[OR]=0.55；95%置信区间[CI]=0.50~0.61；P＜0.01）。在HPV阴性患者中，经多变量Cox回归分析显示，女性患者的总生存期（风险比[HR]=1.24；95%置信区间[CI]=1.12~1.39；P＜0.01）与肿瘤特异性生存期（HR=1.27；95%置信区间[CI]=1.08~1.50；P＜0.01）均更差；而在HPV阳性患者中，男性与女性的总生存期（HR=1.05；95%置信区间[CI]=0.91~1.21；P＝0.45）及肿瘤特异性生存期（HR=1.17；95%置信区间[CI]=0.95~1.45；P＝0.12）均无显著差异。在HPV阳性口咽癌患者中，男女的生存结局无显著差异；而在HPV阴性口咽癌患者中，女性的生存结局较男性更差。