Hallowell Benjamin D, Saraiya Mona, Thompson Trevor D, Unger Elizabeth R, Lynch Charles F, Tucker Tom, Copeland Glenn, Hernandez Brenda Y, Peters Edward S, Wilkinson Edward, Goodman Marc T
Centers for Disease Control and Prevention, Atlanta, GA.
University of Iowa, Iowa City, IA.
JNCI Cancer Spectr. 2018 Jul;2(3). doi: 10.1093/jncics/pky036. Epub 2018 Aug 11.
Human papillomavirus (HPV) genotype influences the development of invasive cervical cancer (ICC); however, there is uncertainty regarding the association of HPV genotype with survival among ICC patients.
Follow-up data were collected from 693 previously selected and HPV-typed ICC cases that were part of the Centers for Disease Control and Prevention Cancer Registry Surveillance System. Cases were diagnosed between 1994 and 2005. The Kaplan-Meier method was used to estimate five-year all-cause survival. A multivariable Cox proportional hazards model was used to estimate the effect of HPV genotype on survival after adjusting for demographic, tumor, and treatment characteristics.
Five-year all-cause survival rates varied by HPV status (HPV 16: 66.9%, HPV 18: 65.7%, HPV 31/33/45/52/58: 70.8%, other oncogenic HPV genotypes: 79.0%, nononcogenic HPV: 69.3%, HPV-negative: 54.0%). Following multivariable adjustment, no statistically significant survival differences were found for ICC patients with HPV 16-positive tumors compared with women with tumors positive for HPV 18, other oncogenic HPV types, or HPV-negative tumors. Women with detectable HPV 31/33/33/45/52/58 had a statistically significant 40% reduced hazard of death at five years (95% confidence interval [CI] = 0.38 to 0.95), and women who tested positive for nononcogenic HPV genotypes had a statistically significant 57% reduced hazard of death at five years (95% CI = 0.19 to 0.96) compared with women with HPV 16 tumors. Few statistically significant differences in HPV positivity, tumor characteristics, treatment, or survival were found by race/ethnicity.
HPV genotype statistically significantly influenced five-year survival rates among women with ICC; however, screening and HPV vaccination remain the most important factors to improve patient prognosis and prevent future cases.
人乳头瘤病毒（HPV）基因型会影响浸润性宫颈癌（ICC）的发展；然而，关于HPV基因型与ICC患者生存率之间的关联仍存在不确定性。
随访数据收集自693例先前入选并进行HPV分型的ICC病例，这些病例是疾病控制与预防中心癌症登记监测系统的一部分。病例诊断时间为1994年至2005年。采用Kaplan-Meier方法估计五年全因生存率。使用多变量Cox比例风险模型来估计在调整人口统计学、肿瘤和治疗特征后HPV基因型对生存率的影响。
五年全因生存率因HPV状态而异（HPV 16：66.9%，HPV 18：65.7%，HPV 31/33/45/52/58：70.8%，其他致癌性HPV基因型：79.0%，非致癌性HPV：69.3%，HPV阴性：54.0%）。多变量调整后，与HPV 18阳性、其他致癌性HPV类型阳性或HPV阴性肿瘤的女性相比，HPV 16阳性肿瘤ICC患者的生存率无统计学显著差异。与HPV 16肿瘤的女性相比，可以检测到HPV 31/33/33/45/52/58的女性在五年时死亡风险显著降低40%（95%置信区间[CI]=0.38至0.95）；非致癌性HPV基因型检测呈阳性的女性在五年时死亡风险显著降低57%（95%CI=0.19至0.96）。按种族/民族划分，在HPV阳性、肿瘤特征、治疗或生存率方面几乎没有统计学显著差异。
HPV基因型对ICC女性的五年生存率有统计学显著影响；然而，筛查和HPV疫苗接种仍然是改善患者预后和预防未来病例的最重要因素。
