HUMAN PAPILLOMAVIRUS DEOXYRIBONUCLEIC-ACID AS A PROGNOSTIC INDICATOR IN EARLY-STAGE CERVICAL-CANCER - A POSSIBLE ROLE FOR TYPE-18

OBJECTIVE: Our purpose was to determine the prognostic significance of human papillomavirus deoxyribonucleic acid in cervical cancers. STUDY DESIGN: The polymerase chain reaction was used to detect human papill omavirus deoxyribonucleic acid types 6, 11, 16, 18, 31, 33, 52, or 58 in tumors from 148 patients (equal numbers of whom were disease free o r had relapses) surgically treated for stage IB or IIA cancers in a ma jor Australian hospital. Cox regression modeling was used to assess th e effect of human papillomavirus status on tumor recurrence, taking in to account patient age, clinical stage, histologic node status, and ty pe of tumor. RESULTS: Seventy of 74 (95%) of the recurring tumors and 62 of 74 (84%) of the nonrecurring tumors were human papillomavirus de oxyribonucleic acid positive. The rates of positivity of types 16 and 18 were 64% versus 31% in the recurrers and 65% versus 14% in the nonr ecurrers. Human papillomavirus type 18 positivity was associated with a greater risk of recurrence than was type 16 positivity (hazard ratio 1.8, p = 0.03). Clinical stage, nodal metastasis, and young age (less than or equal to 35 years) also had adverse effects on relapse (hazar d ratio for each approximately 2). CONCLUSION: Human papillomavirus ty pe 18 positivity is a risk factor for tumor recurrence in surgically t reated cervical cancer.