The purpose of this study was to evaluate if HPV status serves as an independent predictor of early and late dysphagia outcomes when considered alongside standard patient characteristics and dose metrics for head and neck cancer patients treated with radiotherapy. The age, sex, smoking history, cancer type (oropharyngeal vs non-oropharyngeal), HPV status, and early and late dysphagia outcomes were obtained for 99 retrospective head and neck cancer patients treated at our clinic with radiotherapy. Additionally for each patient, the mean radiation dose to the pharynx, superior/middle/inferior pharyngeal constrictor muscles, and cricopharyngeus was calculated. The predictive power of these clinical characteristics and radiation metrics was evaluated using chi-square tests for categorical variables and t-tests for continuous variables. Then multi-variate logistic models were built for each outcome using a single dose metric at a time, and either HPV status, cancer type, or both. Multi-variate models were built using both top-down and bottom-up technique to establish the most predictive independent covariates. In the univariate analysis for early dysphagia, cancer type (p = 0.04) and four dose metrics (p ≤ 0.02) were significantly associated with outcome, while for late dysphagia, only cancer type (p = 0.04) was associated with outcome. In the multivariate analysis for early dysphagia, cancer type, smoking history, and mean dose to the five structures were consistently selected as covariates. For late dysphagia, either HPV status or cancer type was selected in each model and the mean dose to the cricopharyngeus was selected in one model. While HPV is a known contributing factor for tumor prognosis in oropharyngeal cancers, its role in normal tissue toxicities for head and neck cancers has not previously been evaluated. Our results indicate having an oropharyngeal cancer may increase a patient’s risk of high-grade early and late dysphagia while HPV status was seldom selected.

中文翻译：

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评估接受放射治疗的头颈癌患者所经历的毒性的预测因素

本研究的目的是评估 HPV 状态是否作为早期和晚期吞咽困难结果的独立预测因子，与接受放射治疗的头颈癌患者的标准患者特征和剂量指标一起考虑。获得了在我们诊所接受放疗的 99 名回顾性头颈癌患者的年龄、性别、吸烟史、癌症类型（口咽与非口咽）、HPV 状态以及早期和晚期吞咽困难的结果。此外，还计算了每位患者的咽部、上/中/下咽缩肌和环咽的平均辐射剂量。使用分类变量的卡方检验和连续变量的 t 检验评估这些临床特征和辐射指标的预测能力。然后，每次使用单一剂量指标，以及 HPV 状态、癌症类型或两者都为每个结果构建多变量逻辑模型。使用自上而下和自下而上的技术构建多变量模型，以建立最具预测性的独立协变量。在早期吞咽困难的单变量分析中，癌症类型 (p = 0.04) 和四个剂量指标 (p ≤ 0.02) 与结果显着相关，而对于晚期吞咽困难，只有癌症类型 (p = 0.04) 与结果相关。在早期吞咽困难的多变量分析中，癌症类型、吸烟史和五种结构的平均剂量始终被选为协变量。对于晚期吞咽困难，在每个模型中选择 HPV 状态或癌症类型，并在一个模型中选择环咽的平均剂量。虽然 HPV 是口咽癌肿瘤预后的已知促成因素，但其在头颈癌的正常组织毒性中的作用以前尚未得到评估。我们的结果表明，患有口咽癌可能会增加患者发生早期和晚期高度吞咽困难的风险，而很少选择 HPV 状态。