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).
Patients and 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.
Keywords
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Article info
Publication history
Published online: October 01, 2012
Identification
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© 2012 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
