Lukaszuk Krzysztof, Liss Joanna, Gulczynski Jacek, Nowaczyk Monika, Nakonieczny Miroslaw, Piatkowski Mariusz, Sliwinski Wojciech, Baay Marc, Wozniak Izabela, Maj Bozena, Lukaszuk Mariusz
Department of Gynaecological Endocrinology, Medical University of Gdansk, Poland.
Gynecol Oncol. 2007 Mar;104(3):721-6. doi: 10.1016/j.ygyno.2006.10.018. Epub 2006 Dec 6.
High-risk types of HPV are etiological factors in cervical cancer. Lymph node involvement in cervical cancer patients reduces 5-year survival rates by 25-60%. However, the influence on survival of HPV DNA positivity in histopathologically negative lymph nodes remains unresolved.
The study included 116 of 148 patients who underwent Piver type III radical hysterectomy and pelvic lymphadenectomy and who showed HPV DNA positivity in the primary lesion. Lymph node tissues were tested for the presence of HPV DNA, using a PCR technique.
We found the presence of HPV DNA sequences in lymph nodes dissected intraoperatively in 81 (69.83%) cases. In analysis, we compared patients from 3 groups: HPV- and metastatic-negative (LN HPV-M-); HPV-positive metastatic-negative (LN HPV+M-); and metastatic-positive (LN M+). We discovered that survival in groups LN M+ and LN HPV+M- did not differ statistically (p=0.37). However, the survival periods in these two groups differed when compared with LN HPV-M- patients (p<0.001). Using Cox's proportional hazards model, we found that the presence of lymph node HPV DNA, and FIGO stage, and primary lesion volume were independent parameters correlating with survival and mortality risk.
We conclude that the presence of HPV DNA in lymph nodes is an early sign of metastasis and should be treated as such in prognostic outlook and planning the therapeutic strategy.
高危型人乳头瘤病毒（HPV）是宫颈癌的致病因素。宫颈癌患者出现淋巴结转移会使5年生存率降低25%至60%。然而，组织病理学检查呈阴性的淋巴结中HPV DNA阳性对生存率的影响仍不明确。
本研究纳入了148例接受Piver III型根治性子宫切除术和盆腔淋巴结清扫术且原发灶HPV DNA呈阳性的患者中的116例。采用聚合酶链反应（PCR）技术检测淋巴结组织中是否存在HPV DNA。
我们发现术中切除的淋巴结中有81例（69.83%）存在HPV DNA序列。在分析中，我们比较了3组患者：HPV阴性且无转移（LN HPV-M-）；HPV阳性且无转移（LN HPV+M-）；以及有转移（LN M+）。我们发现LN M+组和LN HPV+M-组的生存率在统计学上无差异（p = 0.37）。然而，与LN HPV-M-组患者相比，这两组的生存期存在差异（p < 0.001）。使用Cox比例风险模型，我们发现淋巴结HPV DNA的存在、国际妇产科联盟（FIGO）分期和原发灶体积是与生存和死亡风险相关的独立参数。
我们得出结论，淋巴结中HPV DNA的存在是转移的早期迹象，在预后评估和制定治疗策略时应如此看待。
