Human papillomavirus and prognosis of invasive cervical cancer: a population-based study.
OBJECTIVE
To determine the association between human papillomavirus (HPV) type and prognosis of patients with invasive cervical carcinoma.


METHODS
Patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IB to IV cervical cancer between 1986 and 1997 while residents of three Washington State counties were included (n = 399). HPV typing was performed on paraffin-embedded tumor tissue using polymerase chain reaction methods. Patients were observed for a median of 50.8 months. Total mortality (TM) and cervical cancer-specific mortality (CCSM) were determined. Hazards ratios (HR) adjusted for age, stage, and histologic type were estimated using multivariable models.


RESULTS
Eighty-six patients had HPV 18-related tumors and 210 patients had HPV 16-related tumors. Cumulative TM among patients with HPV 18-related tumors and among patients with HPV 16-related tumors were 33.7% and 27.6%, respectively; cumulative CCSM in these two groups were 26.7% and 18.1%, respectively. Compared with patients with HPV 16-related cancers, patients with HPV 18-related cancers were at increased risk for TM (HR(TM), 2.2; 95% confidence interval [CI], 1.3 to 3.6) and CCSM (HR(CCSM), 2.5; 95% CI, 1.4 to 4.4). The HPV18 associations were strongest for patients with FIGO stage IB or IIA disease (HR(TM), 3.1; 95% CI, 2.3 to 4.2; and HR(CCSM), 5.8; 95% CI, 3.9 to 8.7), whereas no associations were observed among patients with FIGO stage IIB to IV disease. Virtually identical associations were found in the subset of patients with squamous cell carcinoma (n = 219).


CONCLUSIONS
HPV 18-related cervical carcinomas, particularly those diagnosed at an early stage, are associated with a poor prognosis. Elucidating the mechanism or mechanisms underlying this association could lead to new treatment approaches for patients with invasive cervical carcinoma.
Programs in Biostatistics and Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
S M
SM
Schwartz
J R
JR
Daling
K A
KA
Shera
M M
MM
Madeleine
B
B
McKnight
D A
DA
Galloway
P L
PL
Porter
J K
JK
McDougall
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000821:virology; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D014408:Biomarkers, Tumor; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D027383:Papillomaviridae / Q000145:classification*; D030361:Papillomavirus Infections / Q000150:complications* / Q000821:virology; D011379:Prognosis; D016016:Proportional Hazards Models; D012306:Risk; D015996:Survival Rate; D014412:Tumor Virus Infections / Q000150:complications* / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000821:virology*; D014861:Washington / Q000453:epidemiology
D014408:Biomarkers, Tumor; D004279:DNA, Viral