Role of human papillomavirus genotype in prognosis of early-stage cervical cancer undergoing primary surgery.
OBJECTIVE
Our aim was to evaluate the prognostic significance of human papillomavirus (HPV) genotype in early-stage cervical carcinoma primarily treated with surgery in a large tertiary referral medical center.


METHODS
Consecutive patients who underwent primary surgery for invasive cervical carcinoma of International Federation of Gynecology and Obstetrics (FIGO) stage I to IIA between 1993 and 2000 were retrospectively reviewed. Polymerase chain reaction (PCR) using a general primer set followed by reverse-blot detection of 38 types of HPV DNA in a single reaction was performed for genotyping. E6 type-specific PCR was performed to validate multiple types.


RESULTS
A total of 1,067 eligible patients were analyzed. HPV DNA sequences were detected in 95.1% of the specimens, among which 9.6% contained multiple types. HPV 16 was detected in 63.8% of the samples, and HPV 18 was detected in 16.5% of the samples. The median follow-up time of surviving patients was 77 months. By multivariate analysis, FIGO stage, lymph node metastasis, depth of cervical stromal invasion, grade of differentiation, and HPV 18 positivity were significantly related to cancer relapse. FIGO stage II, deep stromal invasion, parametrial extension, HPV 18 positivity, and age older than 45 years were significant predictors for death. Using the seven selected variables from either recurrence-free or overall survival analysis, death-predicting (P < .0001) and relapse-predicting (P < .0001) models classifying three risk groups (low, intermediate, and high risk) were constructed and endorsed by internal validation.


CONCLUSIONS
The independent prognostic value of HPV genotype is confirmed in this study. The prognostic models could be useful in counseling patients and stratifying patients in future clinical trials.
Lai
Chyong-Huey
CH
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kueishan, Taoyuan 333, Taiwan. sh46erry@ms6.hinet.net
Chang
Chee-Jen
CJ
Huang
Huei-Jean
HJ
Hsueh
Swei
S
Chao
Angel
A
Yang
Jung-Erh
JE
Lin
Cheng-Tao
CT
Huang
Shang-Lang
SL
Hong
Ji-Hong
JH
Chou
Hung-Hsueh
HH
Wu
Tzu-I
TI
Huang
Kuan-Gen
KG
Wang
Chun-Chieh
CC
Chang
Ting-Chang
TC
D000328:Adult; D002277:Carcinoma / Q000601:surgery / Q000821:virology*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005838:Genotype; D052162:Human papillomavirus 16 / Q000235:genetics*; D052161:Human papillomavirus 18 / Q000235:genetics*; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications* / Q000821:virology; D011379:Prognosis; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000601:surgery / Q000821:virology*