Department of Radiation Oncology, Chang Gung Memorial Hospital, and Department of Medical Imaging and Radiological Science, Chang Gung University, School of Medicine, Taoyuan, Taiwan.
Int J Radiat Oncol Biol Phys. 2012 Nov 15;84(4):e499-506. doi: 10.1016/j.ijrobp.2012.06.031. Epub 2012 Aug 11.
To study the prognostic value of human papillomavirus (HPV) genotypes in patients with advanced cervical cancer treated with radiation therapy (RT) alone or concurrent chemoradiation therapy (CCRT).
Between August 1993 and May 2000, 327 patients with advanced squamous cell carcinoma of the cervix (International Federation of Gynecology and Obstetrics stage III/IVA or stage IIB with positive lymph nodes) were eligible for this study. HPV genotypes were determined using the Easychip® HPV genechip. Outcomes were analyzed using Kaplan-Meier survival analysis and the Cox proportional hazards model.
We detected 22 HPV genotypes in 323 (98.8%) patients. The leading 4 types were HPV16, 58, 18, and 33. The 5-year overall and disease-specific survival estimates for the entire cohort were 41.9% and 51.4%, respectively. CCRT improved the 5-year disease-specific survival by an absolute 9.8%, but this was not statistically significant (P=.089). There was a significant improvement in disease-specific survival in the CCRT group for HPV18-positive (60.9% vs 30.4%, P=.019) and HPV58-positive (69.3% vs 48.9%, P=.026) patients compared with the RT alone group. In contrast, the differences in survival with CCRT compared with RT alone in the HPV16-positive and HPV-33 positive subgroups were not statistically significant (P=.86 and P=.53, respectively). An improved disease-specific survival was observed for CCRT treated patients infected with both HPV16 and HPV18, but these differenced also were not statistically significant.
The HPV genotype may be a useful predictive factor for the effect of CCRT in patients with advanced squamous cell carcinoma of the cervix. Verifying these results in prospective trials could have an impact on tailoring future treatment based on HPV genotype.
研究人乳头瘤病毒（HPV）基因型在单独接受放射治疗（RT）或同步放化疗（CCRT）治疗的晚期宫颈癌患者中的预后价值。
1993 年 8 月至 2000 年 5 月期间，327 例晚期宫颈鳞状细胞癌患者（国际妇产科联合会[FIGO]分期 III/IVA 期或 IIB 期伴阳性淋巴结）符合本研究条件。使用 Easychip®HPV 基因芯片确定 HPV 基因型。采用 Kaplan-Meier 生存分析和 Cox 比例风险模型分析结果。
我们在 323 例（98.8%）患者中检测到 22 种 HPV 基因型。主要的 4 种类型是 HPV16、58、18 和 33。整个队列的 5 年总生存率和疾病特异性生存率估计分别为 41.9%和 51.4%。CCRT 使 5 年疾病特异性生存率绝对提高了 9.8%，但无统计学意义（P=.089）。在 HPV18 阳性（60.9%比 30.4%，P=.019）和 HPV58 阳性（69.3%比 48.9%，P=.026）患者中，CCRT 组的疾病特异性生存率显著提高与 RT 单独组相比。相比之下，HPV16 阳性和 HPV-33 阳性亚组中，CCRT 与 RT 单独治疗的生存差异无统计学意义（P=.86 和 P=.53）。在接受 CCRT 治疗的同时感染 HPV16 和 HPV18 的患者中观察到疾病特异性生存率提高，但这些差异也无统计学意义。
HPV 基因型可能是预测晚期宫颈鳞状细胞癌患者 CCRT 效果的有用因素。在前瞻性试验中验证这些结果可能会影响根据 HPV 基因型制定未来治疗方案。
