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Das HPV-getriebene Oropharynxkarzinom – Inzidenz, Trends, Diagnose und Therapie

HPV-associated oropharyngeal cancer—incidence, trends, diagnosis, and treatment

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Zusammenfassung

Ansteigende Inzidenzen von Oropharynxkarzinomen (OPSCC) und die Klassifizierung des mit humanen Papillomaviren (HPV-)assoziierten OPSCC als eigene Tumorentität zählen aktuell zu den wichtigen Themen in der Kopf-Hals-Onkologie. HPV ist neben Tabak- und Alkoholkonsum als Risikofaktor und bedeutender Prognosefaktor anerkannt. Ansteigende Inzidenzen von HPV-assoziierten OPSCC gelten als gesichert, dennoch bestehen Probleme in der Vergleichbarkeit von Krebsregister- und Kohorten-basierenden Studien aufgrund uneinheitlicher klinisch-anatomischer Definitionen und der HPV-Diagnostik. HPV-assoziierte OPSCC zeichnen sich durch eine wesentlich bessere Prognose der Patienten aus und sind aufgrund der virusgetriebenen Karzinogenese in vielen molekularbiologischen und genetischen Aspekten von HPV-negativen Tumoren abgrenzbar. Dennoch wird bei der Wahl der Therapie aktuell nicht aufgrund des HPV-Status unterschieden, sondern im Wesentlichen von der individuellen Situation des Patienten und den anatomischen Gegebenheiten ausgegangen. Neue Therapieoptionen eröffnen sich im Bereich der Checkpoint-Immuntherapie, die eine wertvolle Ergänzung zu etablierten Therapien sein wird. Für bestimmte Patientengruppen mit definiertem Risikoprofil könnte eine Therapiedeeskalation (z. B. Verminderung der Strahlendosis) möglich sein. Die prophylaktische HPV-Impfung kann langfristig zur Reduktion HPV-induzierter Erkrankungen wie des HPV-assoziierten OPSCC beitragen – Voraussetzung ist eine hohe Impfbereitschaft in der Bevölkerung. Aufgrund aktueller Impfraten und der langen Latenzzeit zwischen Infektion und HPV-induzierter Karzinogenese muss jedoch weiterhin mit einem Inzidenzanstieg HPV-assoziierter OPSCC gerechnet werden.

Abstract

A rising incidence of oropharyngeal squamous cell carcinoma (OPSCC) is reported by many countries worldwide and OPSCC associated with human papillomavirus (HPV) has been recently defined as a new class of head and neck cancers. Besides tobacco and alcohol consumption, HPV is an accepted risk and prognostic factor for OPSCC. Although the incidence increase of HPV-associated OPSCC is convincing, cancer registry studies and studies based on cohorts often have drawbacks regarding data linkage to comparable experimental data, comparable anatomical definitions or HPV diagnostics. Patients with HPV-associated OPSCC have remarkably better prognosis and the tumors differ from HPV-negative OPSCC with respect to molecular and genetic aspects. Nevertheless, choice of therapy is independent of HPV, and rather is subject to the individual patient’s condition, local preference and anatomic characteristics. New concepts emerge in immune-checkpoint oncology, which might be a valuable add-on to established concepts. Also, treatment de-escalation (e.g., by reduction of radiation dosage) might be suitable for patients with certain risk profiles. Prophylactic vaccination can contribute to reducing HPV-induced disease, likewise OPSCC. Prerequisite is a high rate of vaccination, which is currently not sufficient in Germany. Because of currently low vaccination rates and the rather long time between initial infection and HPV-induced carcinogenesis, reduction of incidence increase or prevalence of HPV-associated OPSCC is not expected in the near future.

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Authors and Affiliations

  1. Klinik für HNO-Heilkunde, Kopf‑, Halschirurgie, Universitätsklinikum Gießen, Justus-Liebig-Universität Gießen, Gießen, Deutschland

    S. Wagner, H. Reder & C. Wittekindt

  2. Kopf-Hals-Tumorforschung, Klinik für HNO-Heilkunde, Kopf‑/Halschirurgie, Justus-Liebig-Universität Gießen, Gießen, Deutschland

    S. Wagner, H. Reder & C. Wittekindt

  3. Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Halschirurgie, Medizinische Fakultät, Universität zu Köln, Köln, Deutschland

    S. J. Sharma,  N. Würdemann & J. P. Klußmann

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  1. S. Wagner
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  2. H. Reder
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  3. S. J. Sharma
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  6. J. P. Klußmann
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Correspondence to N. Würdemann.

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Interessenkonflikt

S. Wagner, H. Reder, S. J. Sharma, N. Würdemann, C. Wittekindt und J. P. Klußmann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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C. Wittekindt und J. P. Klußmann teilen sich gleichberechtigt die Letztautorenschaft.

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Wagner, S., Reder, H., Sharma, S.J. et al. Das HPV-getriebene Oropharynxkarzinom – Inzidenz, Trends, Diagnose und Therapie. Urologe 57, 1457–1463 (2018). https://doi.org/10.1007/s00120-018-0810-4

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  • DOI: https://doi.org/10.1007/s00120-018-0810-4

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