一种基于人乳头瘤病毒 DNA 和肿瘤大小的风险分层新标志物，用于预测局部晚期宫颈癌的生存。

A new marker based on risk stratification of human papillomavirus DNA and tumor size to predict survival of locally advanced cervical cancer.

机构信息

Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.

Department of Clinical Laboratory, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.

出版信息

Int J Gynecol Cancer. 2019 Mar;29(3):459-465. doi: 10.1136/ijgc-2018-000095. Epub 2019 Feb 7.

DOI:10.1136/ijgc-2018-000095

PMID:30733276

Abstract

OBJECTIVE

To assess the prognostic value of human papillomavirus (HPV) viral load in locally advanced cervical carcinoma treated with radical concurrent chemoradiotherapy.

METHODS

From January 2012 to October 2013, a total of 246 locally advanced cervical carcinoma patients were included in this retrospective study. HPV DNA status was tested by Hybrid Capture 2 assay. Tumor size was measured on T2WI. All the patients in the study received concurrent cisplatin-based chemoradiotherapy with intensity-modulated radiotherapy and three-dimensional brachytherapy. Survival rate was calculated by the Kaplan-Meier method, and a log-rank test was used to compare the survival. Multivariate analysis employed the Cox regression model.

RESULTS

The median follow-up time was 52 months. The median value of HPV DNA was 163.13 relative light unit/cut-off (RLU/CO) (range 1.65-2162.62 RLU/CO). The 5-year overall survival, distant metastasis-free survival of patients in the low HPV DNA group (HPV DNA ≤ 163.13 RLU/CO) and the high HPV DNA group (HPV DNA > 163.13 RLU/CO) were 46.3 % vs 58.5 % (p = 0.009) and 65.9 % vs 75.6% (p = 0.003), respectively. Multivariate analysis showed that the HPV DNA, tumor size, and International Federation of Gynecology and Obstetrics (FIGO) stage were independent prognostic factors for overall survival and distant metastasis-free survival. We choose the tumor size and HPV DNA as the risk stratification factors to build a new prediction marker which can better predict overall survival for locally advanced cervical cancer than can the FIGO stage.

CONCLUSIONS

HPV DNA may be a useful biomarker for locally advanced cervical cancer. Low HPV load predicts a worse survival. The new marker based on risk stratification by combining HPV DNA and tumor size is better associated with overall survival of locally advanced cervical cancer treated with concurrent chemoradiotherapy.

摘要

目的

评估人乳头瘤病毒（HPV）病毒载量在接受根治性同期放化疗的局部晚期宫颈癌中的预后价值。

方法

本回顾性研究共纳入 2012 年 1 月至 2013 年 10 月期间的 246 例局部晚期宫颈癌患者。采用杂交捕获 2 法检测 HPV DNA 状态。肿瘤大小在 T2WI 上测量。所有患者均接受顺铂为基础的同期放化疗，采用调强放疗和三维近距离放疗。采用 Kaplan-Meier 法计算生存率，并采用对数秩检验比较生存率。多变量分析采用 Cox 回归模型。

结果

中位随访时间为 52 个月。HPV DNA 的中位值为 163.13 相对光单位/截止值（RLU/CO）（范围 1.65-2162.62 RLU/CO）。低 HPV DNA 组（HPV DNA ≤ 163.13 RLU/CO）和高 HPV DNA 组（HPV DNA > 163.13 RLU/CO）患者的 5 年总生存率、远处无转移生存率分别为 46.3%比 58.5%（p=0.009）和 65.9%比 75.6%（p=0.003）。多变量分析显示，HPV DNA、肿瘤大小和国际妇产科联合会（FIGO）分期是总生存率和远处无转移生存率的独立预后因素。我们选择肿瘤大小和 HPV DNA 作为风险分层因素，构建了一个新的预测标志物，该标志物能更好地预测局部晚期宫颈癌的总生存率，优于 FIGO 分期。