Fuglsang Katrine, Blaakaer Jan, Petersen Lone Kjeld, Mejlgaard Else, Hammer Anne, Steiniche Torben
Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.
Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.
Papillomavirus Res. 2019 Jun;7:15-20. doi: 10.1016/j.pvr.2018.12.001. Epub 2018 Dec 14.
The present study investigated Human Papillomavirus (HPV) DNA genotyping in primary tumor, pelvic lymph nodes (PLN) and recurrence in early-stage cervical cancer patients.
We conducted a hospital-based case-control study. From 2003 to 2015, 282 patients underwent surgery for cervical cancer in the Department of Gynecology, Aarhus University Hospital, Denmark. Twenty-nine recurrent cases were identified. HPV DNA genotyping was performed on formalin-fixed, paraffin-embedded tissue specimens from the primary tumor, PLN, and recurrent disease.
In the primary tumor, HPV DNA was detectable in 18(72%) of 25 tissue specimens from recurrent cases and in 15(83%) of 18 controls. HPV DNA-positive PLN was significantly associated with recurrence, 83%(95%CI: 52-98%), compared to patients with HPV-negative PLN, 38%(95%CI: 18-62%)(p < 0.05). HPV DNA genotyping was positive in eight of 12(67%) patients with recurrent disease. The genotype was identical in all three tissues types. The positive predictive value for recurrence was the same for detection of HPV-DNA and metastases in the PLN, with reasonable sensitivity. The negative predictive value for recurrence, however, was best for HPV-DNA, 62%(95%CI: 38-98%).
In conclusion, our data suggest that the presence of HPV in pelvic lymph nodes is associated with an increased risk of recurrence.
本研究调查了早期宫颈癌患者原发肿瘤、盆腔淋巴结（PLN）中的人乳头瘤病毒（HPV）DNA基因分型及复发情况。
我们开展了一项基于医院的病例对照研究。2003年至2015年期间，丹麦奥胡斯大学医院妇科有282例患者接受了宫颈癌手术。共识别出29例复发病例。对来自原发肿瘤、PLN及复发病灶的福尔马林固定石蜡包埋组织标本进行HPV DNA基因分型。
在原发肿瘤中，25例复发病例组织标本中有18例（72%）检测到HPV DNA，18例对照中有15例（83%）检测到。HPV DNA阳性的PLN与复发显著相关，比例为83%（95%CI：52 - 98%），而HPV阴性PLN的患者复发比例为38%（95%CI：18 - 62%）（p<0.05）。12例复发病例中有8例（67%）HPV DNA基因分型呈阳性。所有三种组织类型中的基因型均相同。PLN中检测HPV - DNA和转移灶对复发的阳性预测值相同，且具有合理的敏感性。然而，对复发的阴性预测值以HPV - DNA最佳，为62%（95%CI：38 - 98%）。
总之，我们的数据表明盆腔淋巴结中存在HPV与复发风险增加相关。
