口腔HPV相关癌症风险不会传给性伴侣

芝加哥——约翰霍普金斯大学彭博公共卫生学院的流行病学专家Gypsyamber D’Souza博士在美国临床肿瘤学会(ASCO)2013年会上报告，人乳头瘤病毒(HPV)阳性口咽癌患者的性伴侣罹患HPV相关癌症的风险并未增加。

由于很多人担心口咽癌患者及其配偶/性伴侣会承受较高的HPV经口腔传播和HPV相关癌症风险，D’Souza博士及其同事开展了这项研究。

研究者共招募147例男性和19例女性(中位年龄56岁)口咽癌患者以及这些患者的94名配偶或长期性伴侣。对所有病例及其性伴侣在基线和1年后收集口腔清洗和漱口标本，检测是否存在HPV DNA。尽管采用这种方式检测HPV在敏感性和特异性方面存在缺陷，该方法仍为检测口腔癌HPV的金标准。

结果显示，诊断时，65%的患者为HPV阳性，所有患者中的54%存在HPV 16。但在1年治疗结束后，仅有5.6%的患者仍为HPV 16阳性。总体上，患者性伴侣的口腔HPV感染率为6.5%，与2009~2010年间全美健康与营养调查(NHANES)中总体人群的HPV感染率相似。在HPV阳性口咽癌患者的88名女性性伴侣中，发现4名为HPV感染阳性，其中2名为致癌性HPV 16亚型感染阳性。这一样本的HPV感染率为5%，与总体女性人群的感染率(3.6%)相似。在男性性伴侣中，HPV感染率也与总体男性人群(10.1%)相似，但因样本数量太少而难以得出有意义的结论。

无1名性伴侣患有口腔或口咽癌，但3例患者报告之前的性伴侣患有口咽癌。并且，5例男性患者报告有一名性伴侣发生宫颈癌或癌前病变(1名当前性伴侣和2名之前性伴侣患有宫颈癌，2名当前性伴侣患有宫颈非典型增生)。

该研究由约翰霍普金斯创新基金资助。D’Souza博士报告接受了由宫颈癌疫苗加德西生产商默克公司提供的研究资助。

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By: NEIL OSTERWEIL, Oncology Practice

CHICAGO – Partners of patients with human papillomavirus-positive oropharyngeal cancer do not appear to be at an increased risk for HPV-related cancers, investigators reported at the annual meeting of the American Society of Clinical Oncology

Of 88 female partners of persons with HPV-positive oropharyngeal cancers, 4 were found to be positive for HPV infection, and 2 of the 4 were positive for the oncogenic HPV-16 subtype. The prevalence of HPV infection in this sample was 5%, similar to that of women in the general population (3.6%), reported Gypsyamber D’Souza, Ph.D., an epidemiologist at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Md.

None of the male partners in this small pilot study tested positive for oral HPV 16, but the male sample size was too small to draw significant conclusions about the risks of HPV transmission in men, Dr. D’Souza said.

"This is the first study to examine oral HPV prevalence among spouses of HPV-related oropharyngeal cancer patients, and it’s very reassuring that the oral HPV prevalence was similar to that observed in the general population. This suggests that risk of HPV-related cancer remains low among these spouses," she said in a media briefing prior to her presentation.

The study also supports epidemiologic data showing that although HPV infections are common in the general population, the overwhelming majority of people who are infected will spontaneously clear the virus and not get cancer.

"We certainly will need longer follow-up on how HPV infection and co-infection in the partners will affect patients and the development of cancer, but we recognize this as an important breakthrough in the understanding of the biology of oropharyngeal cancer," commented Dr. Gregory Masters, a medical oncologist at the Helen F. Graham Cancer Center in Newark, Del., who moderated the briefing.

Dr. Marcia S. Brose, a head and neck surgeon at the Hospital of the University of Pennsylvania in Philadelphia, said that despite the handful of male partners, the study sends an important message to patients and their partners.

"As oncologists, we’re not just in the business of the disease itself; we also have to treat the family members and their concerns. If you’re the spouse of someone who has a communicable disease-related cancer, you’re going to have to make decisions that affect your private life, and it means a lot that someone is doing the research that says you don’t have to worry," she said in an interview.

The study was prompted by concerns frequently expressed by patients with oropharyngeal cancer and their spouses/sexual partners about oral transmission of HPV and increased cancer risk, Dr. D’Souza said.

The investigators enrolled 147 men and 19 women (median age 56) with oropharyngeal cancers, and 94 of their spouses or long-term partners.

Oral rinse and gargle samples were collected from all cases and partners in the study at baseline and 1 year later. The samples were tested for the presence of HPV DNA. Imperfect as it is in sensitivity and specificity for HPV, the test is nonetheless the gold standard for detecting HPV in oral cancers, Dr. D’Souza said.

At the time of diagnosis, 65% of patients tested positive for HPV, and 54% of all patients had HPV 16.

At 1 year, however, following completion of therapy, only 5.6% of patients still tested positive for HPV 16.

Overall, the prevalence of oral HPV among partners was 6.5%, comparable to HPV prevalence among the general population in National Health and Nutrition Examination Survery (NHANES) data from 2009-2010. Among male partners, the prevalence of HPV also was similar to that seen among men in the general population (10.1%), but the small number made it difficult if not impossible to draw meaningful conclusions.

No oral or oropharyngeal cancers were detected in partners in an oral cancer screen, but three patients reported having previous partners with oropharyngeal cancer. In addition, five male patients reported having a partner who developed cervical cancer or a precancerous condition (one current partner and two previous partners had cervical cancers, and two current partners had cervical dysplasia).

The study was supported by the Johns Hopkins Innovation Fund. Dr. D’Souza reported receiving research support from Merck, maker of Gardasil.