Kugelman Nir, Siegler Efraim, Mackuli Lena, Lavie Ofer, Schmidt Meirav, Shaked-Mishan Pninit, Segev Yakir
Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel.
Clinical Serology and Virology Laboratory, Carmel Medical Center, Haifa, Israel.
J Low Genit Tract Dis. 2022 Apr 1;26(2):115-121. doi: 10.1097/LGT.0000000000000650.
The aims of the study were to evaluate the prevalence and prognosis of human papillomavirus (HPV)-negative cervical cancer (CC) and to compare these to data for HPV-positive CC.
This retrospective cohort study compared between HPV-negative CC and HPV-positive CC patients. Primary end points were disease-free survival and overall survival. Secondary end points were demographic and clinical variables including histological diagnosis, stage, and treatment.
Of 233 women with CC, 18 (8%) tested HPV-negative. During a median follow-up of 45 months, 33 (14%) recurrences and 41 (18%) deaths were observed. Eleven of the 18 women (61%) who tested HPV-negative and 41 of the 215 (19%) who tested HPV-positive had only adenocarcinoma (p < .001). In a multivariate logistic regression analysis, advanced age (p = .003) and primary treatment with chemotherapy and/or radiotherapy (p < .001) remained statistically significant for recurrence or mortality (disease-free survival). The factors associated with lower survival were advanced age (p = .008), higher stage at diagnosis (p < .001), and HPV negativity (p = .062). Median overall survival for HPV-positive CC was not reached, compared with 24 months for HPV-negative CC. Kaplan-Meier curves showed lower rates of disease-free survival (p = .008) and overall survival (p = .011), for women with HPV-negative compared with HPV-positive CC.
The relatively poor prognosis of HPV-negative CC is important in light of its relatively high prevalence, which could increase proportionally to HPV-positive CC due to increased HPV screening and vaccination. Further studies are needed to confirm whether HPV status is truly an independent prognostic factor in CC.
本研究旨在评估人乳头瘤病毒（HPV）阴性宫颈癌（CC）的患病率和预后，并将其与HPV阳性CC的数据进行比较。
这项回顾性队列研究对HPV阴性CC患者和HPV阳性CC患者进行了比较。主要终点是无病生存期和总生存期。次要终点是人口统计学和临床变量，包括组织学诊断、分期和治疗。
在233例CC女性患者中，18例（8%）检测为HPV阴性。在中位随访45个月期间，观察到33例（14%）复发和41例（18%）死亡。18例HPV阴性女性中有11例（61%），215例HPV阳性女性中有41例（19%）仅患有腺癌（p<0.001）。在多因素逻辑回归分析中，高龄（p=0.003）以及以化疗和/或放疗作为初始治疗（p<0.001）对于复发或死亡率（无病生存期）仍具有统计学意义。与较低生存率相关的因素包括高龄（p=0.008）、诊断时分期较高（p<0.001）和HPV阴性（p=0.062）。HPV阳性CC的中位总生存期未达到，而HPV阴性CC为24个月。Kaplan-Meier曲线显示，与HPV阳性CC女性相比，HPV阴性CC女性的无病生存率（p=0.008）和总生存率（p=0.011）较低。
鉴于HPV阴性CC的患病率相对较高，其相对较差的预后具有重要意义，由于HPV筛查和疫苗接种增加，HPV阴性CC的患病率可能会与HPV阳性CC成比例增加。需要进一步研究以确认HPV状态是否真的是CC的独立预后因素。
