【摘要】 目的 探究血清外泌体miR-496与口咽鳞状细胞癌（OPSCC）患者人乳头瘤病毒（HPV）状态及预后的相关性。方法 在这项前瞻性队列研究中，共纳入2012年1月至2021年12月期间≥60岁新诊断的原发性OPSCC患者119例，包括84例HPV阳性患者和35例HPV阴性患者。通过逆转录定量聚合酶链式反应检测血清外泌体miR-496表达。随访记录患者的总生存期（OS）及无进展生存期（PFS）。另外招募60例健康个体作为对照。结果 HPV阳性患者血清外泌体miR-496表达水平低于健康受试者[0.58(0.31,0.81)vs. 1.08(0.75,1.33),P <0.05]和HPV阴性患者[0.58(0.31,0.81)vs. 1.01(0.72,1.25),P <0.05]，但是HPV阴性患者血清外泌体miR-496表达水平与健康受试者相比无统计学差异（P> 0.05）。血清外泌体miR-496水平可以良好地区分HPV阳性OPSCC患者和健康受试者，特异性和敏感性分别为79.80%和95.0%。低miR-496表达亚组HPV阳性OPSCC患者的中位无进展生存期（27.6个月vs.65.8个月，2=11.448,P=0.001）、总生存期（29.5个月vs.69.2个月，2=6.948,P=0.008）均显著低于高miR-496表达亚组，且血清外泌体miR-496表达水平降低是HPV阳性OPSCC患者疾病进展、死亡的独立危险因素（P <0.05）。结论 血清外泌体miR-496可作为≥60岁HPV阳性OPSCC患者诊断和预后的一个有前景的标志物。更多还原

【Abstract】 Objective To explore the correlation between serum exosome miR-496 and human papillomavirus(HPV) status and prognosis in patients with oropharyngeal squamous cell carcinoma(OPSCC). Methods In this prospective cohort study, a total of 119 patients( ≥ 60 yrs) with newly diagnosed primary OPSCC between January 2012 and December 2021 were included, including 84 HPV positive patients and 35 HPV negative patients. The expression of miR-496 in serum exosomes was detected by reverse transcription quantitative polymerase chain reaction.The overall survival(OS) and progression free survival(PFS) were recorded during follow-up. In addition, 60 healthy individuals were recruited as controls. Results The expression level of exosomal miR-496 in HPV positive patients was lower than that in healthy subjects [0.58(0.31, 0.81) vs. 1.08(0.75, 1.33), P <0.05] and HPV negative patients [0.58(0.31, 0.81) vs. 1.01(0.72, 1.25), P <0.05], but there was no statistical difference between the expression level of exosomal miR-496 in HPV negative patients and healthy subjects(P >0.05). The serum exosomal miR-496 level can well distinguish HPV positive OPSCC patients from healthy subjects, with specificity and sensitivity of 79.80%and 95.0%, respectively. The median progression free survival(27.6 months vs. 65.8 months, 2=11.448, P=0.001) and overall survival(29.5 months vs. 69.2 months, 2=6.948, P=0.008) of HPV positive OPSCC patients in the low miR-496expression subgroup were significantly lower than those in the high miR-496 expression subgroup, and the decreased expression of exosomal miR-496 in serum was an independent risk factor for disease progression and death in HPV positive opscc patients(P <0.05). Conclusion Serum exosomal miR-496 may serve as a promising marker for diagnosis and prognosis of HPV positive OPSCC patients( ≥ 60 yrs).更多还原