title: Human papillomavirus type and tobacco use as predictors of survival in early stage cervical carcinoma.
abstract: OBJECTIVE
  Molecular and environmental co-factors are known risk factors for cervical cancer. The aim of this study was to define the prognostic significance of HPV 18 and its phylogenetically related viruses and smoking on survival in patients with early stage cervical cancer.
  
  
  METHODS
  HPV typing was performed on stage IB-IIB cervical tumors. Subjects positive for HPV 18 or 45 were compared to the remainder of the cohort and to women with tumors containing HPV 16, 31, or 52. Tobacco use was ascertained by patient questionnaire.
  
  
  RESULTS
  Tumors of 255 women were evaluated. The presence of HPV 18 or 45 was associated with decreased survival. In a multivariable Cox proportional hazards analysis comparing patients with HPV 18 or 45 containing tumors to the rest of the cohort, the hazard ratio for death from cervical cancer was 2.08 (95% CI, 1.07-4.04). The hazard ratio for death from cervical cancer was 2.41 (95% CI, 1.17-4.96) when the HPV 18 and 45 group was compared to women with HPV 16 or its related viruses, 31 and 52. Smoking was associated with a decreased survival for women with HPV 18 or 45, even after adjusting for other known prognostic factors (P = 0.031).
  
  
  CONCLUSIONS
  In addition to pathologic indicators, molecular and environmental co-factors are important determinates of outcome in early stage cervical cancer. The presence of HPV 18 or 45 is associated with a decreased survival. The adverse effect of HPV 18 and 45 on survival is compounded by tobacco use.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, 4911 Barnes Hospital Plaza, Box 8064, St. Louis, MO 63110, USA. wrightj@msnotes.wustl.edu
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.forename: Jianduan
authors.initials: J
authors.lastname: Li
authors.forename: Daniela S
authors.initials: DS
authors.lastname: Gerhard
authors.forename: Zhengyan
authors.initials: Z
authors.lastname: Zhang
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Huettner
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Powell
authors.forename: Randall K
authors.initials: RK
authors.lastname: Gibb
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
authors.forename: David G
authors.initials: DG
authors.lastname: Mutch
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Trinkaus
authors.forename: Janet S
authors.initials: JS
authors.lastname: Rader
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications*; D011379:Prognosis; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000209:etiology / Q000401:mortality* / Q000473:pathology / Q000821:virology*