de Cremoux Patricia, de la Rochefordière Anne, Savignoni Alexia, Kirova Youlia, Alran Séverine, Fourchotte Virginie, Plancher Corine, Thioux Martine, Salmon Rémy J, Cottu Paul, Mignot Laurent, Sastre-Garau Xavier
Department of Tumour Biology, Institut Curie, Paris, France.
Int J Cancer. 2009 Feb 15;124(4):778-82. doi: 10.1002/ijc.24075.
Human papillomavirus (HPV) DNA sequences are associated with the large majority of invasive cervical carcinoma but the role of specific genotype(s) in the outcome of the disease is still debated. To determine the viral epidemiology in the French population of patients and the prognostic value of HPV genotypes in cervical cancer, we performed a retrospective study in 515 patients treated in our Institution from 1985 to 2005. Ninety-six percent of the cases were found associated with HPV DNA whereas 4% remained HPV negative. High-risk HPV 16/18 genotypes were found in 70% of the cases. HPV 18 was more frequently associated with adenocarcinoma (40.6%) than HPV 16 (10.4%) and found in tumours developed in younger women (mean age, 45.8 years) than HPV 16 (48.3 years) or other HPV types (53.6 years). In multivariate analysis, node involvement (p < 0.0001), parametria invasion (p = 0.009), tumour size (p = 0.01) and HPV status (p = 0.02) were associated with disease-free survival (median follow-up 95 months). Disease outcome was better in tumours associated with intermediate risk HPV types (HPV 31, 33, 35, 39, 52, 53, 58, 59, 73) than in tumours with high oncogenic types (HPV 16, 18, 45) (p = 0.03). Node status and tumour size remained prognostic factor for overall survival. Our data show that HPV genotype is one of the biological factors associated with the outcome of cervical cancer. One third of invasive carcinoma were not associated with HPV 16/18, indicating that the screening for cervical neoplasia should be maintained after prophylactic vaccination against these HPV genotypes.
人乳头瘤病毒（HPV）DNA序列与绝大多数浸润性宫颈癌相关，但特定基因型在该疾病预后中的作用仍存在争议。为了确定法国患者人群中的病毒流行病学情况以及HPV基因型在宫颈癌中的预后价值，我们对1985年至2005年在我院接受治疗的515例患者进行了一项回顾性研究。96%的病例被发现与HPV DNA相关，而4%的病例HPV检测仍为阴性。70%的病例中发现高危HPV 16/18基因型。与HPV 16（10.4%）相比，HPV 18更常与腺癌相关（40.6%），并且在较年轻女性（平均年龄45.8岁）发生的肿瘤中发现的频率高于HPV 16（48.3岁）或其他HPV类型（53.6岁）。多因素分析显示，淋巴结受累（p < 0.0001）、宫旁浸润（p = 0.009）、肿瘤大小（p = 0.01）和HPV状态（p = 0.02）与无病生存期相关（中位随访95个月）。与中等风险HPV类型（HPV 31、33、35、39、52、53、58、59、73）相关的肿瘤的疾病预后优于具有高致癌性类型（HPV 16、18、45）的肿瘤（p = 0.03）。淋巴结状态和肿瘤大小仍是总生存期的预后因素。我们的数据表明，HPV基因型是与宫颈癌预后相关的生物学因素之一。三分之一的浸润性癌与HPV 16/18不相关，这表明在针对这些HPV基因型进行预防性疫苗接种后，仍应继续进行宫颈癌前病变的筛查。
