Introduction/Background*Metastatic involvement of lymph nodes (LNs) represents one of the most important prognostic parameter in cervical cancer patients. According to the stage it shortens the 5years survival rate by 25-60 %. Moreover, even in low risk group without any risk factor, a part of radicaly treated patiens suffer from relapse of the disease. Presence of HPV DNA in LNs had been therefore studied as a potential marker of unrecognized metastatic involvement.
Methodology Detected were 13 genotypes of high-risk HPV in the lymphatic tissue harwested from patiens who underwent radical hysterectomy with sentinel node biopsy and pelvic lymphadnectomy or paraaortic LN staging. The cytobrush technique was used for perioperative sample collection from the tumour and fresh lymphatic tissue. Only patients with HPV positive tumours who finished their treatment were included and followed.
Result(s)*Out of 119 patients who were included in the study, 93 had available data from their follow-up; 68 underwent radical surgery and 25 were treated by primary definitive radiotherapy. All 19 patients with metastaticaly involved LNs also had HPV in LNs. Another 23 patients had HPV in uninvolved LNs. After a mean follow up of 147 months 19 patients (5 early and 14 localy advanced stages) recurred and died. The majority of them (13/19) had HPV DNA in their LNs, but only 7 had metastases in the LNs at the same time. Only 6 patients (6.5%) without HPV DNA in LNs recurred – 2 early and 4 localy advanced stages. Negative predictive value for recurrence in cases with HPV negative LNs reached 87.8% in the whole cohort and 95% in early stages.
Conclusion*Our pilot study shows that the presence of HPV DNA in LNs is a promising marker of occult metastatic involvement. Its prognostic value should be confirmed in a prospective trial.
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