Human papillomavirus and prognosis of invasive cervical cancer: A population-based study

Purpose: To determine the association between human papillomavirus (HPV) ty pe and prognosis of patients with invasive cervical carcinoma. Patients and Methods: patients diagnosed with International Federation of G ynecology and Obstetrics (FIGO) stage IB to IV cervical cancer between 1986 and 1997 while residents of three Washington State counties were included (n = 399). HPV typing was performed on paraffin-embedded tumor tissue using polymerase chain reaction methods. Patients were observed for a median of 50.8 months. Total mortality (TM) and cervical cancer-specific mortality (C CSM) were determined. Hazards ratios (HR) adjusted for age, stage, and hist ologic type were estimated using multivariable models. Results: Eighty-six patients held HPV 18-related tumors and 210 patients ha d HPV 16-related tumors. Cumulative TM among patients with HPV 18-related t umors and among patients with HPV 16-related tumors were 33.7% and 27.6%, r espectively; cumulative CCSM in these two groups were 26.7% and 18.1%, resp ectively. Compared with patients with HPV 16-related cancers, patients with HPV 18-related cancers were at increased risk for TM (HRTM, 2.2; 95% confi dence interval [CI], 1.3 to 3.6) and CCSM (HRCCSM, 2.5; 95% CI, 1.4 to 4.4) . The HPV18 associations were strongest for patients with FIGO stage IB or IIA disease (HRTM, 3.1; 95% CI, 2.3 to 4.2; and HRCCSM 5.8; 95% CI, 3.9 to 8.7), whereas no associations were observed among patients with FIGO stage IIB to IV disease. Virtually identical associations were found in the subse t of patients with squamous cell carcinoma (n = 219). Conclusion: HPV 18-related cervical carcinomas, particularly those diagnose d at an early stage, are associated with a poor prognosis. Elucidating the mechanism or mechanisms underlying this association could lead to new treat ment approaches for patients with invasive cervical carcinoma. (C) 2001 by American Society of Clinical Oncology.