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Laryngorhinootologie 2024; 103(04): 296-313
DOI: 10.1055/a-2133-2348
Facharztwissen HNO

Update: Epidemiologie und Prävention des Oropharynxkarzinoms

Update: Epidemiology and Prevention of Oropharyngeal Cancer
Andreas Dietz
,
Gunnar Wichmann
,
Susanne Wiegand
,
Tim Waterboer
,
Wilfried Budach
,
Jens Peter Klußmann
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Beim Oropharynxkarzinom unterscheidet man inzwischen abhängig davon, ob eine HPV-16-Infektion ursächlich vorliegt oder nicht, in 2 verschiedene Entitäten. Neuere Daten zeigen ein diverses Bild der Bedeutung und Prävalenz des Surrogatparameters p16 (Diskordanz) für eine tatsächliche HPV-16-Assoziation. Im Rahmen der Präventionsmöglichkeiten kommt der Impfung eine hohe und dem HPV-Screening gesunder Menschen eine geringe Bedeutung zu.

Abstract

Due to the association with the causal HPV-16 infection, the oropharyngeal carcinoma spreads into two separate entities depending on HPV-16 positivity. More recent data show a diversified picture of the importance and prevalence of the surrogate parameter p16 (discordance) for a definitive HPV-16 association, which varies worldwide. In the context of prevention options, vaccination is of major and HPV screening of healthy people only of little importance.

Kernaussagen

  • Insgesamt kann für Deutschland ein klarer Anstieg der HPV-assoziierten OPSCC festgestellt werden, wobei eine genaue Wachstumsrate nicht benannt werden kann. Der Trend des Anstiegs ist gegenüber den USA etwas zeitversetzt, aber gleichermaßen ausgeprägt.

  • Man geht heute davon aus, dass es sich bei HPV-assoziierten OPSCC um eine genetisch diverse, von HPV-negativen OPSCC unterscheidbare eigene Tumorsubgruppe handelt.

  • Hauptrisikofaktoren für das Auftreten eines OPSCC (HPV-16-/p16-negativ) sind chronischer Tabak- oder Alkoholabusus, wesentlich seltener auch andere Faktoren. Beide Tumorentitäten sind daher überwiegend Noxen-getriggert.

  • Die zurzeit gängigste Methode zum „Nachweis“ einer HPV-Infektion ist die p16-Immunhistologie.

  • Patienten mit diskordantem OPSCC (p16–/HPV+ oder p16+/HPV–) haben eine signifikant schlechtere Verlaufsprognose als Patienten mit p16+/HPV+-OPSCC und eine signifikant bessere Prognose als Patienten mit p16–/HPV–-OPSCC.

  • Die p16-Diskordanz in Deutschland erreicht in der vorliegenden Literatur bis zu 23%.

  • Somit erscheint ein zusätzlicher, HPV-spezifischer Nachweis über virale DNA oder RNA in Kombination mit der p16-IHC insbesondere in Deutschland für die wahre HPV-Zuordnung erforderlich und insbesondere für den Einschluss von Patienten in klinischen Studien obligat.

  • Kritisch wird von zahlreichen Autoren in Deutschland darauf hingewiesen, dass das reine HPV-16-assoziierte, nicht Noxen-getriggerte OPSCC in Deutschland nur sehr selten vorkommt. Die überwiegende Mehrzahl der Patienten (nicht genau bezifferbar) weist eine Mischung aus p16-Positivität und vorhandener Noxen-Exposition auf. Insofern verwischen die Grenzen der vermeintlich als unterschiedlich zu betrachtenden beiden OPSCC-Entitäten.

  • Ein Screening auf Rachenkrebs kann gegenwärtig selbst bei Hochrisikogruppen nicht empfohlen werden, da der Nachweis der Wirksamkeit, also einer Senkung von Inzidenz und Mortalität, gegenwärtig fehlt.

  • Die Ständige Impfkommission (STIKO) empfiehlt die Impfung gegen HPV für Mädchen und Jungen im Alter von 9–14 Jahren.

Schlüsselwörter

Oropharynxkarzinom - p16 - HPV-16 - Prävention - Impfung - Vorsorge-Screening

Keywords

Oropharynx carcinoma - p16 - HPV-16 - prevention - vaccination - screening


Publication History

Article published online:
02 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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