人乳头状瘤病毒相关性口咽鳞状细胞癌的临床病理学特征分析

张岩; 陈彤箴; 朱晓丽; 李小秋

doi:10.19401/j.cnki.1007-3639.2022.01.006

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人乳头状瘤病毒相关性口咽鳞状细胞癌的临床病理学特征分析

论著 | 更新时间：2025-12-31

- 人乳头状瘤病毒相关性口咽鳞状细胞癌的临床病理学特征分析
- Analysis of clinicopathological features of human papilloma virus-associated oropharyngeal squamous cell carcinoma
- 中国癌症杂志 2022年32卷第1期页码：47-53
- 作者机构：
  
  复旦大学附属肿瘤医院病理科,复旦大学医学院肿瘤学系,复旦大学病理研究所,上海 200032
- 作者简介：
  
  李小秋 E-mail: leexiaoqiu@hotmail.com
- 基金信息：
  
  上海市科学技术委员会科研计划项目(19MC1911000);上海市临床重点专科建设项目-病理科(shslczdzk01301)
- DOI：10.19401/j.cnki.1007-3639.2022.01.006
  中图分类号： R739.63
- 收稿：2021-07-05，
  
  修回：2021-12-01，
  
  纸质出版：2022-01-30
- 稿件说明：
移动端阅览
张岩, 陈彤箴, 朱晓丽, 等. 人乳头状瘤病毒相关性口咽鳞状细胞癌的临床病理学特征分析[J]. 中国癌症杂志, 2022,32(1):47-53.

Yan ZHANG, Tongzhen CHEN, Xiaoli ZHU, et al. Analysis of clinicopathological features of human papilloma virus-associated oropharyngeal squamous cell carcinoma[J]. China Oncology, 2022, 32(1): 47-53.
张岩, 陈彤箴, 朱晓丽, 等. 人乳头状瘤病毒相关性口咽鳞状细胞癌的临床病理学特征分析[J]. 中国癌症杂志, 2022,32(1):47-53. DOI： 10.19401/j.cnki.1007-3639.2022.01.006.

Yan ZHANG, Tongzhen CHEN, Xiaoli ZHU, et al. Analysis of clinicopathological features of human papilloma virus-associated oropharyngeal squamous cell carcinoma[J]. China Oncology, 2022, 32(1): 47-53. DOI： 10.19401/j.cnki.1007-3639.2022.01.006.

摘要

背景与目的：

人乳头状瘤病毒相关性口咽鳞状细胞癌（human papilloma virus-associated oropharyngeal squamous cell carcinoma

OPSCC-HPV）是一种独立的肿瘤类型

发病率有明显上升趋势。探讨OPSCC-HPV的临床病理学特征。

方法：

对复旦大学附属肿瘤医院2013年10月

#x02014;2019年7月诊断的64例OPSCC-HPV患者的临床特征、组织学形态及免疫组织化学表型加以分析

并分别以聚合酶链反应和原位杂交的方法检测肿瘤组织中HPV及Epstein-Barr病毒（Epstein-Barr virus

EBV）的感染情况。

结果：

男性50例

女性14例;发病年龄33~76岁。发病部位以扁桃体最为常见

其次为口咽壁和舌根。36例以进行性增大的颈部包块为首发症状

57例伴颈部淋巴结转移（30例伴囊性变）。55例可知美国癌症联合会（American Joint Committee on Cancer

AJCC）临床TNM总分期

与第7版分期相比

第8版分期明显降级

52例系TNM分期

#x02160;~

#x02161;期病变

3例系

#x02162

;期病变。

#x02160;~

#x02161;期增加85.4%

#x02162;期降低52.7%

#x02163;期降低32.7%

新旧两版临床TNM总分期一致率仅为3.6%（2/55）。随访2~77个月

2例局部复发

6例颈部淋巴结转移

3例死亡。63例为非角化性鳞状细胞癌

1例为腺鳞癌。肿瘤细胞核浆比高

核分裂象易见。免疫组织化学染色显示

60例受检患者中

59例P16弥漫强阳性

24例Ki-67增殖指数较高。39例均为高危型HPV感染

HPV-16型占92.3%

35例患者同时行P16和HPV检测

二者一致率达到97.1%。

结论：

OPSCC-HPV具有独特的临床病理学特征。所有原发性OPSCC及原发部位不明的颈淋巴结转移性鳞状细胞癌均应行P16或HPV检测。

Abstract

Background and purpose:

Human papilloma virus-associated oropharyngeal squamous cell carcinoma (OPSCC-HPV) is a distinct entity with a significantly increasing incidence. This study aimed to observe the clinicopathological features of OPSCC-HPV.

Methods:

The clinical characteristics

histological morphology and immunohistochemical phenotypes of 64 cases of OPSCC-HPV who were diagnosed in Fudan University Shanghai Cancer Center from October 2013 to July 2019 were analyzed. The status of HPV and Epstein-Barr virus (EBV) in tumor tissue was detected respectively by polymerase chain reaction (PCR) and

in situ

hybridization.

Results:

There were 50 male and 14 female patients

with the age at presentation ranging from 33 to 76 years. The tonsil was the most frequently involved site

followed by the oropharyngeal wall and the base of tongue. A total of 36 patients presented with a progressively enlarged neck mass as an initial symptom

and 57 patients had cervical lymph node metastases (30 with cystic changes). The overall TNM clinical staging of American Joint Committee on Cancer (AJCC) were obtained in 55 cases. Compared to the 7th edition staging rules

the 8th edition overall clinical staging was significantly degraded. Fifty-two cases and 3 cases were diagnosed as stage

#x02160;-

#x02161; and

#x02162;

respectively. Proportion of stage

#x02160;-

#x02161; disease increased by 85.4%

and stage

#x02162; and

#x02163; diseases reduced by 52.7% and 32.7%

respectively. The consistency

rate of the 7th and 8th edition clinical TNM staging was only 3.6% (2/55). During the follow-up time ranging from 2 months to 77 months

2 patients developed local recurrence

6 patients had cervical lymph node metastasis and 3 patients died. Sixty-three cases were non-keratinizing squamous cell carcinoma (SCC) and 1 case was adenosquamous carcinoma. Tumor cells displayed a high nuclear/cytoplasmic ratio and increased mitotic activity. Immunohistochemical staining showed that P16 was diffusely and strongly positive in 59 of 60 tested cases

and Ki-67 proliferation index was high in 24 cases. High-risk virus infection was found in all 39 patients with HPV-16 type accounting for 92.3%. A total of 35 patients underwent P16 and HPV tests simultaneously with a consistency of 97.1%.

Conclusion:

OPSCC-HPV has unique clinicopathological features. P16 or HPV detection should be performed on all primary OPSSC and cervical lymph node metastasis of unknown primary.

关键词

Keywords

references

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