Cuschieri K, Brewster D H, Graham C, Nicoll S, Williams A R W, Murray G I, Millan D, Johannessen I, Hardie A, Cubie H A
Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
Int J Cancer. 2014 Dec 1;135(11):2721-6. doi: 10.1002/ijc.28902. Epub 2014 Apr 29.
While much is known about the influence of HPV type on the progression of pre-invasive cervical lesions, the impact of HPV type on cervical cancer prognosis is less evidenced. Thus, we assessed the impact of HPV type on the survival of women diagnosed with cervical cancer. A total of 370 cases of cervical cancer were assessed. Univariate analysis is presented using Kaplan-Meier survival curves and log-rank statistics and multivariable Cox proportional hazard models were generated using age group, socio-economic deprivation, FIGO stage, differentiation and HPV type. HPV grouping was considered in a number of ways with particular reference to the presence or absence of HPV 16 and/or 18. In the univariate analysis, FIGO, age at diagnosis and treatment were associated with poorer survival (p < 0.0001) as was absence of HPV 16 and/or 18 (p = 0.0460). The 25% mortality time in the non-HPV 16/18 vs. HPV16/18 positive group was 615 days and 1,307 days respectively. An unadjusted Cox PH model based HPV16/18 vs. no HPV 16/18 resulted in a hazard ratio of 0.669 (0.450, 0.995). Adjusting for deprivation, FIGO and age group resulted in a hazard ratio of 0.609 (0.395, 0.941) p = 0.025. These data indicate that cancers associated with HPV 16 and/or 18 do not confer worse survival compared to cancers associated with other types, and may indicate improved survival. Consequently, although HPV vaccine is likely to reduce the incidence of cervical cancer it may not indirectly improve cervical cancer survival by reducing the burden of those cancers caused by HPV16/18.
虽然人们对人乳头瘤病毒（HPV）类型对宫颈浸润前病变进展的影响了解甚多，但HPV类型对宫颈癌预后的影响却鲜有证据支持。因此，我们评估了HPV类型对被诊断为宫颈癌女性生存率的影响。共评估了370例宫颈癌病例。单因素分析采用Kaplan-Meier生存曲线和对数秩统计，多变量Cox比例风险模型则根据年龄组、社会经济剥夺程度、国际妇产科联盟（FIGO）分期、分化程度和HPV类型生成。HPV分组通过多种方式进行考量，特别参考了HPV 16和/或18的有无情况。在单因素分析中，FIGO分期、诊断和治疗时的年龄与较差的生存率相关（p < 0.0001），HPV 16和/或18缺失也与较差生存率相关（p = 0.0460）。非HPV 16/18阳性组与HPV16/18阳性组的25%死亡时间分别为615天和1307天。基于HPV16/18与无HPV 16/18的未调整Cox PH模型得出的风险比为0.669（0.450，0.995）。对剥夺程度、FIGO分期和年龄组进行调整后，风险比为0.609（0.395，0.941），p = 0.025。这些数据表明，与HPV 16和/或18相关的癌症与其他类型相关的癌症相比，生存率并不会更差，甚至可能表明生存率有所提高。因此，尽管HPV疫苗可能会降低宫颈癌的发病率，但它可能无法通过减轻由HPV16/18引起的那些癌症负担来间接提高宫颈癌的生存率。
