据研究人员声称，定量PCR检测唾液和血浆有望成为人类乳头状瘤病毒（HPV）相关

的口咽鳞状细胞癌的新的监测工具。来自于约翰霍普金斯医学研究机构的Joseph A.

博士声称，在理想状态下，人们会将这种类型的测试整合成一个监测计划，对于检

测阳性的唾液或血浆病人，可以获得更加强化的监控，包括更加频繁的体检、内窥

镜检查或成像检测来监测早期复发以及治疗阶段。

此外，该测试的另外一个应用是将患者进行分层，将患者分为加强治疗或额外治疗的

患者，因为那些HPV阳性的病人在其复发率增加之前，就要首先进行积极治疗。

PCR-Based Tests Promising in Surveillance of HPV-Related Oropharyngeal Cancer

By Will Boggs MD

August 08, 2014

NEW YORK (Reuters Health) - Quantitative PCR-based tests of saliva and plasma show promise as a surveillance tool for human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma, researchers say.

"Ideally one would integrate this type of testing into a surveillance plan for patients in which those that test positive by a saliva or plasma test would receive more intensive surveillance, potentially including more frequent physical exam, endoscopy, or imaging to detect recurrence at an earlier, more treatable stage," said Dr. Joseph A. Califano from Johns Hopkins Medical Institutions in Baltimore, Maryland.

"Another potential use is to stratify patients into those that may require more intensive or additional therapy from the outset of treatment, since those that are HPV positive prior to therapy are at increased risk for recurrence," he told Reuters Health by email.

Previous studies have shown that it is feasible to quantify HPV-16 oncoproteins E6 and E7 from saliva and from serum and to use the results in disease surveillance for HPV-16-related oropharyngeal squamous cell carcinoma (OPSCC).

Dr. Califano and colleagues evaluated HPV-16 status in saliva and plasma samples using quantitative PCR for HPV-16 E6 and E7 DNA and sought to correlate the results with disease outcomes in a study of 93 patients with OPSCC or unknown primary squamous cell carcinoma.

Of the 81 patients with HPV-16-positive tumors and 12 patients with HPV-16-negative tumors, 14 and five, respectively, developed recurrence after completing their treatment. None of the patients with unknown primary SCC developed recurrence.

No patient with HPV-16-negative tumors had HPV-16 DNA detected in screening saliva or plasma samples, for a specificity of 100% for both samples, the researchers report in JAMA Otolaryngology - Head & Neck Surgery, online July 31.

Among the patients with HPV-16-positive tumors, 53% had positive pretreatment saliva samples and 67% had positive pretreatment plasma samples. The sensitivity of testing for detection of HPV-16 increased to 76% with the combination of saliva and plasma testing.

Posttreatment plasma HPV DNA status was not significantly associated with overall survival, but posttreatment saliva HPV DNA positivity (and the combination of saliva and plasma HPV DNA positivity) predicted significantly worse overall survival.

In predicting the recurrence of OPSCC within three years, the sensitivity of HPV-16 DNA positivity was 19% for saliva, 55% for plasma, and 70% for the combination of plasma and saliva HPV-16 status. Specificity for the combination was 91%.

"It is pretty clear from the study that the combination of plasma and saliva has a better performance than either test alone," Dr. Califano said.

"I would hope that physicians recognize that highly sensitive DNA-based assays for HPV show real potential as surveillance tools for patients with oropharynx," Dr. Califano said. "Currently this test is not available as a CLIA-certified test, so it would be difficult to recommend this test as part of routine surveillance."

SOURCE: http://bit.ly/1nvf8xJ

JAMA Otolaryngol Head Neck Surg 2014.