title: Clinical implications of human papillomavirus genotype in cervical adeno-adenosquamous carcinoma.
abstract: BACKGROUND
  Our aims were to evaluate the genotype distribution of human papillomavirus (HPV) and the correlation between HPV parameters and clinicopathological/treatment variables with prognosis in cervical adeno-adenosquamous carcinoma (AD/ASC).
  
  
  METHODS
  Consecutive patients who received primary treatment for cervical AD/ASC International Federation of Gynecology and Obstetrics (FIGO) stages I-IV between 1993 and 2008 were retrospectively reviewed. Prognostic models were constructed and followed by internal validation with bootstrap resampling.
  
  
  RESULTS
  A total of 456 AD/ASC patients were eligible for HPV genotyping, while 452 were eligible for survival analysis. HPV18 was detected in 51.5% and HPV16 in 36.2% of the samples. Age >50 years old, FIGO stages III-IV and HPV16-negativity were significantly related to cancer relapse, and age >50, FIGO stages III-IV, HPV16-negativity and HPV58-positivity were significant predictors for cancer-specific survival (CSS) by multivariate analyses. HPV16-positivity was also significantly associated with good prognosis in those receiving primary radiotherapy or concurrent chemoradiation (RT/CCRT) (CSS: hazard ratio 0.41, 95% confidence interval 0.21-0.78). Patients with FIGO stages I-II and HPV16-negative AD/ASC treated with primary RH-PLND had significantly better CSS (p<0.0001) than those treated with RT/CCRT.
  
  
  CONCLUSIONS
  Age >50 years old, FIGO stages III-IV and HPV16-negativity were significant poor prognostic factors in cervical AD/ASC. Patients with HPV16-negative tumour might better be treated with primary surgery (e.g. radical hysterectomy for stages I-II and pelvic exenteration for stage IVA). Those with unresectable HPV16-negative tumour (stage IIIB) should undergo CCRT in combination with novel drugs. The inferences of a single-institutional retrospective study require prospective studies to confirm.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan. sh46erry@ms6.hinet.net
authors.forename: Chyong-Huey
authors.initials: CH
authors.lastname: Lai
authors.forename: Hung-Hsueh
authors.initials: HH
authors.lastname: Chou
authors.forename: Chee-Jen
authors.initials: CJ
authors.lastname: Chang
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Wang
authors.forename: Swei
authors.initials: S
authors.lastname: Hsueh
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Huang
authors.forename: Yu-Ruei
authors.initials: YR
authors.lastname: Chen
authors.forename: Hsiu-Ping
authors.initials: HP
authors.lastname: Chang
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Chang
authors.forename: Cheng-Tao
authors.initials: CT
authors.lastname: Lin
authors.forename: Angel
authors.initials: A
authors.lastname: Chao
authors.forename: Jian-Tai
authors.initials: JT
authors.lastname: Qiu
authors.forename: Kuan-Gen
authors.initials: KG
authors.lastname: Huang
authors.forename: Tse-Ching
authors.initials: TC
authors.lastname: Chen
authors.forename: Mei-Shan
authors.initials: MS
authors.lastname: Jao
authors.forename: Min-Yu
authors.initials: MY
authors.lastname: Chen
authors.forename: Jui-Der
authors.initials: JD
authors.lastname: Liou
authors.forename: Chu-Chun
authors.initials: CC
authors.lastname: Huang
authors.forename: Ting-Chang
authors.initials: TC
authors.lastname: Chang
authors.forename: Bruce
authors.initials: B
authors.lastname: Patsner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018196:Carcinoma, Adenosquamous / Q000473:pathology / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005838:Genotype; D052162:Human papillomavirus 16 / Q000302:isolation & purification; D052161:Human papillomavirus 18 / Q000302:isolation & purification; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D027383:Papillomaviridae / Q000145:classification* / Q000235:genetics; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000821:virology*
chemical_list: D004279:DNA, Viral