Poor clinical outcome in early stage cervical cancer with human papillomavirus-18 positive lymph nodes

Epidemiologic and molecular studies have proven that human papillomavirus ( HPV) plays an important role in the development of cervical cancer. However , the role of the virus in the progression of the disease, i.e. in the deve lopment of lymph node metastasis and in the adverse clinical outcome is poo rly understood. We have been using the polymerase chain reaction (PCR) to s tudy the presence and typing of human papillomavirus DNA since 1980 in cerv ical cancers and pelvic lymph nodes from the same patients. Out of the seri es of 47 cervical cancer patients we focused on four women (age: 41, 33, 35 and 56 years) in this article. The follow-up of these patients revealed ea rly recurrences of the disease (7, 7, 17, 22 months) with very short surviv al (9, 10, 21, 24 months). Although we detected HPV-18 positivity both in t he cervical tumors and in the regional lymph nodes too in all four cases, l ymph nodes were negative by routine hystology in case of the three young pa tients (21, 33, 35 years of age). Our observations suggest that HPV type 18 positive cervical cancer patients, despite negative histological findings in the lymph nodes should be consider as a subpopulation for poor outcome e specially in the young age group (p=0,022, Fisher's exact test). (C) 2000 E lsevier Science Ireland Ltd. All rights reserved.