目的 探讨p16蛋白表达情况在局部晚期喉癌及下咽癌患者综合治疗预后预测中的价值。 方法 回顾性分析2021年1月至2024年1月于本院接受综合治疗的118例局部晚期（Ⅲ—ⅣA期）喉癌及下咽癌患者的临床资料。采用免疫组化法检测p16蛋白表达情况。根据患者p16检测结果划分为p16阳性组与p16阴性组，对比分析两组间临床病理特征的差异，运用Kaplan-Meier法绘制生存曲线，分别评估两组的总生存期（OS）和无进展生存期（PFS），并通过Log-rank检验进行组间生存差异分析。采用Cox比例风险回归模型，进一步探讨影响患者预后的独立危险因素。 结果 p16阳性率为26.27%（31/118）。p16阳性组在Ⅳ期、低分化以及淋巴结转移方面的占比均高于阴性组（P < 0.05）。p16阴性组的中位OS为36.90个月（95% CI： 33.29 ~ 40.51），p16阳性组的中位OS尚未达到（Log-rank χ2 = 9.667，P = 0.002）。p16阳性组患者中位PFS高于p16阴性组［39.12个月（95%CI： 35.88 ~ 42.39）vs. 34.68个月（95% CI： 31.56 ~ 37.81），Log-rank χ2 = 9.347，P = 0.002］。在CCRT亚组（n = 66）中，p16阳性患者的中位OS优于p16阴性患者（中位OS 未达到vs. 37.5个月，Logχ² = 8.854，P = 0.003）。多因素Cox回归分析结果显示，吸烟≥ 10年、饮酒量≥ 40 g/d、淋巴结转移、分化程度及p16蛋白表达情况是影响患者OS与PFS的独立危险因素。 结论 p16蛋白表达情况是局部晚期喉癌及下咽癌的独立危险因素，检测p16蛋白表达有助于预后分层，为个体化治疗提供参考。

Objective To investigate the prognostic significance of p16 protein expression in patients with locally advanced laryngeal and hypopharyngeal carcinoma who are undergoing comprehensive treatment. Methods A retrospective analysis was carried out on the clinical data of 118 patients diagnosed with locally advanced （Stage Ⅲ - ⅣA） laryngeal or hypopharyngeal carcinoma， who underwent comprehensive treatment at our institution from January 2021 to January 2024. The p16 protein expression was detected via immunohistochemistry. Patients were stratified according to their p16 protein expression into positive and negative groups to compare their clinicopathological characteristics. The Kaplan-Meier method was employed to plot survival curves and compute overall survival （OS） and progression-free survival （PFS）， and inter-group comparisons were conducted using the Log-rank test. Independent prognostic factors were identified by means of a Cox proportional hazards regression model. Results The p16-positive rate was 26.27% （31 out of 118）. When compared with the p16-negative group， the p16-positive group exhibited a significantly higher proportion of patients with Stage IV disease， poor differentiation， or lymph node metastasis （all P < 0.05）. Patients in the p16-negative group had a shorter median overall survival （OS） of 36.90 months （95%CI： 33.29 - 40.51）， whereas the median OS was not reached in the p16-positive group （Log-rank P = 0.002）. The p16-positive group also demonstrated a superior median progression-free survival （PFS） ［39.12 months （95%CI： 35.88 - 42.39） compared to 34.68 months （95%CI： 31.56 - 37.81）， Log-rank χ2 = 9.347， P = 0.002］. In the concurrent chemoradiotherapy （CCRT） subgroup （n = 66）， p16-positive patients had a better median OS than p16-negative patients （median OS not reached versus 37.5 months， log-rank χ2 = 8.854， P = 0.003）. Multivariate Cox regression analysis revealed that smoking for ≥ 10 years， alcohol consumption ≥ 40 g/day， lymph node metastasis， tumor differentiation grade， and p16 protein expression were independent prognostic factors influencing both OS and PFS. Conclusion The p16 protein expression serves as an independent prognostic factor in locally advanced laryngeal and hypopharyngeal carcinoma. Conducting tests for the p16 protein expression facilitates prognostic stratification and offers a reference for individualized treatment.