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Humane Papillomaviren und das Oropharynxkarzinom

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Human papillomavirus and oropharyngeal squamous cell carcinoma

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Zusammenfassung

Hintergrund

Das humane Papillomavirus (HPV) gehört zur Familie der Papillomaviren. Basierend auf dem karzinogenen Potenzial der Viren erfolgt die Einteilung in Niedrig- und Hochrisikotypen. Niedrigrisikotypen sind verantwortlich für genitale Papillome und die rekurrierende respiratorische Papillomatose, während HPV-Hochrisikotypen weltweit 5 % der Karzinome induzieren. HPV gilt als sexuell übertragbare Erkrankung und ist, neben der Entstehung anogenitaler Karzinome, im Kopf-Hals-Bereich für die Pathogenese des HPV-assoziierten Oropharynxkarzinoms (OPSCC) verantwortlich.

Methoden

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed zum Thema HPV-assoziierte OPSCC.

Ergebnisse

Die Inzidenz dieser vorrangig in der Tonsille sowie im Zugengrund lokalisierten HPV-assoziierten Kopf-Hals-Karzinome steigt. Aufgrund der virusgetriebenen Karzinogenese unterscheiden sich HPV-assoziierte OPSCC hinsichtlich genetischer und molekularbiologischer Aspekte von den noxenassoziierten OPSCC und weisen im Vergleich eine signifikant verbesserte Prognose auf. Der Nachweis einer HPV-Assoziation erfolgt u. a. über den immunhistochemischen Nachweis einer Überexpression des Surrogatmarkers p16, welcher seit 2017 in der 8. Auflage der TNM-Klassifikation maligner Tumoren berücksichtigt wird. Bisher wird bei der Wahl der Therapie nicht aufgrund des HPV-Status unterschieden, welches in beiden Entitäten zu einer hohen Nebenwirkungsrate führt.

Schlussfolgerung

Um zukünftig eine Therapiedeeskalation bestimmter Patientengruppen zu ermöglichen, wurden prognostische Modelle zur Risikostratifizierung entwickelt. Zur Überwachung des Krankheitsverlaufs sowie der frühzeitigen Detektion eines Therapieversagens werden aktuell Screeningmethoden wie die Flüssigbiopsie auf ihre Validität geprüft. Die HPV-Impfung, welche der primären Prophylaxe einer Tumorentstehung dient, wird für Mädchen sowie seit kurzem auch für Jungen im Alter von 9 bis 14 Jahren von der Ständigen Impfkommission (STIKO) empfohlen.

Abstract

Introduction

The human papillomavirus (HPV) belongs to the papillomavirus family. Based on the carcinogenic potential of the virus, it is classified into low-risk and high-risk types. Low-risk types are responsible for the development of genital papillomas and recurrent respiratory papillomatosis, whereas 5% of all carcinomas worldwide are caused by HPV high-risk types. HPV is considered a sexually transmitted disease and is not only responsible for the development of anogenital carcinomas but also for a subgroup of HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) in the head and neck area.

Methods

This work is based on a selective literature search in the PubMed database on the subject of HPV-associated OPSCC.

Results

The OPSCCs are located primarily in the tonsils or base of the tongue and represent a tumor entity with a significantly increasing incidence. Due to virus-driven carcinogenesis, these tumors differ from smoking and alcohol-associated OPSCC in both genetic and molecular biological aspects and are distinguished by a significantly improved prognosis. HPV-association is confirmed by the expression of the surrogate marker p16, which has been included in the 8th edition of the TNM classification of malignant tumors since 2017. Nevertheless, the choice of treatment is currently not based on HPV status, which leads to a high rate of side effects in both entities.

Conclusion

Prognostic models for risk stratification have been developed in order to enable treatment deintensification for certain patient groups in the future. In order to monitor the course of disease and early detection of treatment failure, current screening and surveillance methods, such as liquid biopsy are being tested. The HPV vaccination, which serves as a primary prophylaxis with respect to tumor development, is recommended by the Standing Vaccination Committee for girls and recently also for boys aged 9–14 years.

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Authors and Affiliations

  1. Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Halschirurgie, Medizinische Fakultät, Universität zu Köln, Kerpener Str. 62, 50931, Köln, Deutschland

    Nora Wuerdemann & Jens Peter Klussmann

  2. Kopf-Hals-Tumorzentrum des Comprehensive Cancer Center Ulm, Klinik für Hals‑, Nasen‑, Ohrenheilkunde und Kopf-Hals-Chirurgie, Universitätsklinik Ulm, Ulm, Deutschland

    Johannes Doescher, Simon Laban & Thomas K. Hoffmann

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  1. Nora Wuerdemann
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  2. Johannes Doescher
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  3. Simon Laban
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Correspondence to Nora Wuerdemann.

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Interessenkonflikt

S. Laban: Advisory Boards: AstraZeneca (AZ), Merck Sharp & Dohme (MSD). Vortragshonorare: Bristol-Myers Squibb (BMS), Merck Serono, MSD. T.K. Hoffmann: Advisory Board für MSD. Vortragshonorare: Merck Serono, BMS. N. Wuerdemann, J. Doescher 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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Wuerdemann, N., Doescher, J., Laban, S. et al. Humane Papillomaviren und das Oropharynxkarzinom. Onkologe 25, 224–231 (2019). https://doi.org/10.1007/s00761-018-0519-4

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  • DOI: https://doi.org/10.1007/s00761-018-0519-4

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