近几十年来，口咽鳞状细胞癌（OPSCC）的发病率增加，人乳头瘤病毒（HPV）感染是OPSCC的主要原因。了解死因（CODs）数据对于指导后续策略和修订处理相关COD的预防性治疗策略至关重要。然而，对于HPV状态下的竞争性COD的研究有限，尤其是在OPSCC患者中。我们的目的是分析HPV状态下的OPSCC竞争性COD的分布。我们回顾性地纳入了2010年至2015年间来自美国监测、流行病学和终止结果数据库的I-IVB期OPSCC患者。分析了HPV状态与头颈癌特异性死亡率（HNCSM）、第二原发癌死亡率（SPCM）和非癌症致死率（NCCM）之间的关联。统计分析使用卡方检验、Kaplan-Meier分析和Fine和Gray模型。我们共纳入了5852名患者，其中73.2%（n=4283）的患者患有与HPV相关的肿瘤。共有1537名（26.3%）患者死亡，其中789名（51.3%）因头颈癌、333名（21.7%）因第二原发癌，415名（27%）因非癌症原因死亡。5年内HNCSM、SPCM、NCCM和总体死亡率分别为14.7%、6.5%、7.7%和26.4%。与HPV阴性疾病相比，HPV阳性疾病的HNCSM累积发生率较低（亚分布风险比[sHR] 0.362，95% CI 0.315-0.417；P<.001），SPCM（sHR 0.400，95% CI 0.321-0.496；P<.001）和NCCM（sHR 0.460，95% CI 0.378-0.560；P<.001）。在HPV阴性疾病中，5年内HNCSM的风险为26.9%，而在HPV阳性疾病中为10.7%（P<.001）。在HPV阴性疾病中，5年内SPCM的风险为12.4%，而在HPV阳性疾病中为4.6%（P<.001）。在HPV阴性疾病中，5年内NCCM的风险为13.7%，而在HPV阳性疾病中为5.8%（P<.001）。使用Fine和Gray竞争风险模型，我们的结果显示HPV阴性肿瘤的HNCSM（P<.001）、SPCM（P<.001）和NCCM（P<.001）风险明显高于HPV阴性肿瘤。与HPV阴性OPSCC相比，HPV阳性OPSCC的NCSM、SPCM和NCCM较低。HPV阳性是克服癌症和减少OPSCC其他COD风险的有利预后因素。我们的发现支持根据HPV状态为OPSCC患者量身定制随访策略。©Dong-Dong Zhang, Min Lei, Yue Wang, Pei-Ji Zeng, Yong-Jun Hong, Cheng-Fu Cai. 原载于JMIR公共卫生与监测 (https://publichealth.jmir.org)，2023年8月29日发表。

The incidence of oropharyngeal squamous cell carcinomas (OPSCC) has increased in recent decades, and human papillomavirus (HPV) infection is the main cause of OPSCC. The data regarding causes of death (CODs) are vitally important in informing follow-up strategies and revising treatment strategies to deal with any possible preventable treatment-related COD. However, limited studies have assessed the competing COD by HPV status in patients with OPSCC.We aimed to analyze the distribution of the competing COD according to HPV status in OPSCC.We retrospectively included stage I-IVB patients with OPSCC from the Surveillance, Epidemiology, and End Results database between 2010 and 2015. The association between HPV status and head and neck cancer-specific mortality (HNCSM), second primary cancer mortality (SPCM), and noncancer-caused mortality (NCCM) were analyzed. The chi-square test, Kaplan-Meier analysis, and Fine and Gray model were used for statistical analysis.We included 5852 patients in this study and 73.2% (n=4283) of them had HPV-related tumors. A total of 1537 (26.3%) patients died, including 789 (51.3%), 333 (21.7%), and 415 (27%) patients who died from head and neck cancer, second cancer, and noncancer causes, respectively. The 5-year HNCSM, SPCM, NCCM, and overall mortality were 14.7%, 6.5%, 7.7%, and 26.4%, respectively. Those with HPV-positive disease had a lower cumulative incidence of HNCSM (subdistribution hazard ratio [sHR] 0.362, 95% CI 0.315-0.417; P<.001), SPCM (sHR 0.400, 95% CI 0.321-0.496; P<.001), and NCCM (sHR 0.460, 95% CI 0.378-0.560; P<.001) than those with HPV-negative disease. The 5-year risk of HNCSM was 26.9% and 10.7% in those with HPV-negative and HPV-positive disease, respectively (P<.001). The 5-year risk of SPCM was 12.4% and 4.6% in those with HPV-negative and HPV-positive disease, respectively (P<.001). The 5-year risk of NCCM of death was 13.7% and 5.8% in those with HPV-negative and HPV-positive disease, respectively (P<.001). Using the Fine and Gray competing-risks model, our results show that those with HPV-negative tumors had a significantly higher risk of HNCSM (P<.001), SPCM (P<.001), and NCCM (P<.001) than those with HPV-negative tumors.HPV-positive OPSCC has a lower NCSM, SPCM, and NCCM as compared to those with HPV-negative OPSCC. HPV positivity is a favorable prognostic factor in the context of overcoming cancer as well as in terms of reducing the risk of other CODs in OPSCC. Our finding supports the need to tailor patient follow-up based on the HPV status of patients with OPSCC.©Dong-Dong Zhang, Min Lei, Yue Wang, Pei-Ji Zeng, Yong-Jun Hong, Cheng-Fu Cai. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 29.08.2023.