Early stage cervical cancers containing human papillomavirus type 18 DNA have more nodal metastasis and deeper stromal invasion.
Early stage cervical cancers containing human papillomavirus type 18 DNA have more nodal metastasis and deeper stromal invasion.
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发表时间：
2003-09
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通讯作者：
S. Im;S. Wilczynski;R. Burger;B. Monk
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作者：
S. Im;S. Wilczynski;R. Burger;B. Monk
目的探讨人乳头瘤病毒（HPV）18型DNA阳性的早期宫颈癌预后不良的临床和病理因素。实验设计：对144例IB期宫颈癌患者行广泛性子宫切除术和双侧盆腔淋巴结清扫术的临床和病理进行回顾性分析。采用PCR方法对新鲜肿瘤标本进行HPV分型。分析了临床病理信息、复发部位、辅助放疗的使用和生存数据。结果33例（23%）肿瘤中含有HPV 18 DNA。这些肿瘤与含有非HPV 18 DNA的肿瘤在肿瘤等级或大小方面没有差异。然而，含有HPV 18的癌症更可能是腺癌。HPV 18组盆腔淋巴结转移率（48%）高于非HPV 18组（28%），HPV 18相关肿瘤中更深的间质浸润更常见。虽然含有HPV 18的肿瘤患者接受辅助放疗的比例（67%）略高于非HPV 18癌症患者（49%），但复发在HPV 18患者中更常见。11例（33%）含HPV 18的癌症复发，而18例（16%）不含HPV 18的肿瘤复发。结论：IB期含HPV 18 DNA的宫颈癌行根治性子宫切除术和双侧盆腔淋巴结清扫术治疗预后较差的原因似乎与更深的宫颈间质浸润和更多的淋巴结转移有关。尽管辅助放射治疗的使用增加，这些癌症仍然更容易复发。
PURPOSE To investigate the clinical and pathological factors which might explain the poor prognosis associated with early stage cervical cancers containing human papillomavirus (HPV) type 18 DNA. EXPERIMENTAL DESIGN A clinical and pathological review of 144 patients with stage IB cervical cancer treated with radical hysterectomy and bilateral pelvic lymph node dissection was done. HPV genotyping was determined from fresh tumor specimens through PCR. Clinical-pathological information, sites of recurrence, use of adjuvant radiation, and survival data were analyzed. RESULTS Thirty-three (23%) tumors contained HPV 18 DNA. These tumors did not differ from those which contained non-HPV 18 DNA with respect to tumor grade or size. However, HPV 18-containing cancers were more likely to be adenocarcinomas. A higher incidence of pelvic lymph node metastasis was noted among the HPV 18 group (48%) as compared with the non-HPV 18 group (28%), and deeper stromal invasion was more common in HPV 18-associated tumors. Although a slightly higher proportion of patients with HPV 18-containing tumors received adjuvant radiation (67%) than those with non-HPV 18 cancers (49%), recurrences were more common among HPV 18 patients. Eleven (33%) of HPV 18-containing cancers relapsed compared with 18 (16%) of non-HPV18-containing tumors. CONCLUSIONS The explanation for the worse prognosis associated with stage IB cervical cancers containing HPV 18 DNA treated with radical hysterectomy and bilateral pelvic lymph node dissection appears to be related to deeper cervical stromal invasion and more nodal metastases. Despite an increased use of adjuvant radiation therapy, these cancers are still more likely to relapse.