title: Persistence of human papillomavirus infection as a predictor for recurrence in carcinoma of the cervix after radiotherapy.
abstract: OBJECTIVE
  This study was undertaken to examine a possible correlation between clearance or persistence of human papillomavirus (HPV) infection and radiation response in carcinoma of the cervix.
  
  
  METHODS
  We reviewed 97 patients with HPV-positive cervical squamous cell carcinoma (International Federation of Gynecology and Obstetrics [FIGO] stage IB-IVA) treated with radiotherapy. Examination of HPV DNA was performed by the polymerase chain reaction-based assay.
  
  
  RESULTS
  Cervical HPV DNA cleared in 42 patients (43.3%) and persisted in 55 patients (56.7%) at the end of irradiation. All of 42 HPV-cleared patients (100.0%) and 50 of 55 HPV-persistent patients (90.9%) had complete response. Of 92 patients with complete response, 20 (21.7%) had local recurrence develop. The recurrence rate was significantly higher in HPV-persisted patients (34.0%) than in HPV-cleared patients (7.1%) ( P = .0016). Univariate analysis demonstrated the significant differences for both 5-year local disease-free survival (LDFS) and overall survival (OAS) between HPV-cleared and HPV-persisted groups. Multivariate analysis showed that persistence of HPV DNA was the most powerful independent predictor for LDFS and OAS compared with other prognostic factors, such as FIGO stage or node swelling.
  
  
  CONCLUSIONS
  In HPV-positive cervical carcinoma, persistence of HPV DNA in the cervix at the end of irradiation was highly predictive of LDFS and OAS.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of the Ryukyus, 207 Uehara Nishihara-Machi, Nakagami-Gun, Okinawa 903-0215, Japan. ynagai@med.u-ryukyu.ac.jp
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nagai
authors.forename: Takashi
authors.initials: T
authors.lastname: Toma
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Moromizato
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Maehama
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Asato
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Kariya
authors.forename: Koji
authors.initials: K
authors.lastname: Kanazawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000532:radiotherapy / Q000821:virology*; D015331:Cohort Studies; D015897:Comorbidity; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000821:virology; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy / Q000821:virology*
chemical_list: D004279:DNA, Viral