RT Journal Article
SR Electronic
T1 Human papillomavirus independent status on pathologic response and outcomes in locally advanced cervical cancer managed with chemoradiotherapy followed by surgery
JF International Journal of Gynecologic Cancer
JO Int J Gynecol Cancer
FD BMJ Publishing Group Ltd
SP 489
OP 497
DO 10.1136/ijgc-2022-003940
VO 33
IS 4
A1 Turco, Luigi Carlo
A1 Pedone Anchora, Luigi
A1 Fedele, Camilla
A1 Inzani, Frediano
A1 Piermattei, Alessia
A1 Martini, Maurizio
A1 Volpe, Mariaconcetta
A1 Marchetti, Simona
A1 Santangelo, Rosaria
A1 Bizzarri, Nicolò
A1 Cosentino, Francesco
A1 Vargiu, Virginia
A1 De Ninno, Maria
A1 Macchia, Gabriella
A1 Valentini, Vincenzo
A1 Zannoni, Gianfranco
A1 Scambia, Giovanni
A1 Ferrandina, Gabriella
YR 2023
UL http://ijgc.bmj.com/content/33/4/489.abstract
AB Objective While human papillomavirus (HPV) has been shown to play a significant role in cervical cancer carcinogenesis (HPV associated cases), a considerable percentage of cervical cancers occur independently of HPV status (HPV independent).Methods In this retrospective study of 254 locally advanced cervical cancer patients treated with chemoradiotherapy and radical surgery, HPV genotypes were determined using the Anyplex II HPV28 kit that uses multiplex, real time polymerase chain reaction technology. The primary endpoints of this study were to evaluate the complete response to chemoradiotherapy (pathologic complete response), the presence of microscopic (<3 mm, pathologic micro partial response, group 1) and macroscopic (>3 mm, pathologic macro partial response, group 2) residual carcinoma in the cervix, and the persistence of metastatic lymph nodes (group 3) in HPV independent cervical cancers. Secondary endpoints were evaluation of disease-free survival and overall survival.Results Of 254 patients studied, 21 cases (8.3%) of cervical cancer were determined to be HPV independent. The percentage of pathologic complete response was found to be higher in the HPV associated group compared with the HPV independent group (p<0.001). In the HPV associated cervical cancer group, 5 year disease free survival was found to be 80.8% versus 59.9% in the HPV independent group (p=0.014). Overall survival was also higher in the HPV associated group (87.9%) compared with the HPV independent patients (69.4%) (p=0.023). In the multivariate analysis, the International Federation of Gynecology and Obstetrics (FIGO) stage and HPV genotypes maintained their relevant impact on pathologic complete response to chemoradiotherapy: FIGO stages IIIC1 and IIIC2 were associated with a 13-fold increased risk for the presence of metastatic lymph nodes compared with group 1 (p<0.001). HPV independent cervical cancers showed the highest risk for the development of macroscopic/stable disease (p=0.007), and persistence of metastatic lymph nodes (p=0.004) versus group 1, respectively.Conclusions This study showed that HPV status at diagnosis could be a relevant factor for clinical outcomes in locally advanced cervical cancer patients.Data are available upon reasonable request.