Survival Analysis Of HPV Associated Oropharyngeal Carcinoma Based On The New Clinical Staging System

Objective:To compare three methods detection of human papillomavirus associated oropharyngeal squamous cell carcinoma(SCC),including brush cytology of oropharynx,P16immunohistochemistry(IHC)and HPV polymerase chain reaction(PCR),and provided the basis for the applicable detection method for HPV of oropharyngea scc in this experiment.By comparing the prognostic difference between the new and old versions of the TNM staging of HPV-positive patients,understand the advantages of the new version and provide clinical evidence for the precise diagnosis and treatment of HPV-related oropharyngeal cancer.To compare the prognosis of patients with HPV positive base on the new and old TNM staging system,grasp the merits of the new version and the purpose is to provide clinical testimony and useful information to instruct the diagnosis and treatment of HPV-related oropharyngeal scc.Methods:171 patients with oropharyngeal scc diagnosed from January 2017 to January 2020,were tested for HPV using the three methods of brush cytology,P16 IHC and PCR,compared the positive detection rate,clinical operability and cost of the three methods,to provide basis for HPV-related oropharyngeal scc detection methods.According to the inclusion criteria,296 surgical patients who were diagnosed with oropharyngeal scc from January 2014 to January2019 were selected.And 68 HPV-positive patients were detected by P16 IHC method,analyze the clinical and pathological data,according to the new and old TNM staging system,the degradation situation was understood,we count the survival rate of patients in each stage,and use SPSS 22.0 statistical software to analyze the prognosis difference with the new and old TNM staging.Results:The positive rates of HPV in 171 patients with oropharyngeal scc detected by P16 IHC,brush cytology and PCR were 25.7%,14.6% and 24.0%.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).The sixty-eight HPV positive oropharyngeal scc patients were classified according to the 7th and 8th edition staging,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.The3-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),and stage III was 66.8% and 37.0%(P = 0.043),74.8% and 0.00% in IV stage(P =0.000),respectively.The survival rates of early stage patients(stagesⅠandⅡ)in the 7th and 8th edition staging 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).According to the 7th edition staging system of HPV positive patients,the survival rates of early and late patients were78.8% and 71.2%(P = 0.982).According to the 8th edition staging system,the survival rates of early and late patients were 82.7% and 27.8%(P = 0.000).Comparing patients with N2a-N2 b and N1、N2c in the 7th edition staging,the survival rates were 92.6% and 76.2%(P= 0.198),92.6% and 33.3%(P = 0.014).According to the 7th edition staging system,the survival rates of patients with N1 and N2 were 76.2% and 84.1%(P = 0.458).And according to the 8th edition staging system,the survival rates of patients with N1 and N2 were 86.3%and 33.3%(P = 0.042).Conclusion:Through comprehensive evaluation of the positive detection rate,clinical operability and cost and other aspects,brush cytology test should not be used as a single standard for the diagnosis of HPV positive oropharyngeal scc.P16 IHC and PCR have their advantages and disadvantages,the selection should be based on the actual condition as the basis of clinical diagnosis.For patients with HPV oropharyngeal cancer,the new staging is more in line with the actual clinical situation,the prognostic stratification is clearer,the staging and prognosis are in good agreement,and it can better guide clinical decision-making,help promote personalized diagnosis and treatment program,and is worthy of clinical application.