OBJECTIVE: To evaluate the prognostic implication of human papillomavirus (HPV) viral load in cervical cancer patients who underwent radical hysterectomy. METHODS: We conducted a retrospective review of patients with stage IA2 through stage IIIA cervical carcinoma who underwent radical hysterectomy at Sun Yat-sen University Cancer Center between January 2005 and December 2009. Patients who had undergone preoperative hybrid capture 2 testing to detect HPV DNA were included. A total of 346 patients positive for HPV DNA were enrolled and stratified into two groups according to the median HPV viral load. RESULTS: HPV viral load was significantly correlated with lymphovascular space invasion (p=0.026) and deep stromal invasion (p=0.024). However, other factors, such as age, stage, histologic grade, histologic type, lymph node metastasis, and tumor size, were not significantly associated with viral load. Low HPV viral load was correlated with poor disease-free survival in univariate analysis (p=0.037) and multivariate analysis (p=0.027). There was no significant difference in overall survival with regard to initial HPV viral load. CONCLUSION: Low initial HPV viral load may be a poor prognostic factor for cervical cancer patients who have undergone radical hysterectomy.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell/*diagnosis/surgery/virology ; Female ; Humans ; Middle Aged ; Papillomaviridae/*isolation & purification ; Papillomavirus Infections/complications/diagnosis/surgery/virology ; Prognosis ; Retrospective Studies ; Treatment Outcome ; Uterine Cervical Neoplasms/*diagnosis/surgery/virology ; *Viral Load ; Young Adult

OBJECTIVETo evaluate clinical characteristics, prognosis, prognostic factors, and the ideal treatment of the young patients with cervical malignant tumor.

METHODSWe analyzed retrospectively 52 cervical malignant tumor patients younger than 35 years (study group) and 45 cervical carcinoma patients older than 50 years (control group) who were admitted in Peking Union Medical College Hospital from 1985 to 2002. The data were analyzed statistically by SPSS10.0. The ovarian functions were evaluated by the questionnaire and the serum sex hormone assay.

RESULTSIn study group, the median age was (31.0 +/- 0.6) years old. The most common clinical symptoms were contact bleeding and irregular bleeding; 55.8% of patients had more than one symptom. HPV positive rate was 20.5%, which was higher than control group significantly (P < 0.05). The percentage of advanced stage (stage II b-stage IV b) of disease in study group and control group were 30.8% and 22.2%, respectively, the difference was significant (P < 0.05). The most common histological type was squamous cell carcinoma (71.2%) in study group, while the percentage of non-squamous cell carcinoma (43.8%) in patients younger than 30 years was much higher than control group (P < 0.05). All the histological type was non-squamous cell carcinoma in the patients younger than 25 years. Histological grade showed that G1, G2, and G3 were 21.2%, 54.5%, and 24.2% respectively in study group. The percentage of bulky cervix (tumor diameter > 4 cm) in study group and control group was 27.9% and 2.7% respectively (P < 0.005). The overall 5-year survival rates were 75.7% in study group, lower than control group (P < 0.05). The COX hazards regression model showed histological type (P = 0.003) and bulky cervix (P = 0.001) were of significant prognostic values.

CONCLUSIONSThere are more advanced stage carcinoma and non-squamous cell carcinoma patients with poor prognosis in study group. The treatment to younger patients should be concerned individually, as well as preservation of reproductive and female endocrine function should be considered.

Adenocarcinoma ; diagnosis ; surgery ; virology ; Adult ; Age Factors ; Carcinoma, Squamous Cell ; diagnosis ; surgery ; virology ; Female ; Humans ; Middle Aged ; Neoplasm Staging ; Ovarian Function Tests ; Papillomaviridae ; isolation & purification ; Papillomavirus Infections ; Prognosis ; Regression Analysis ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms ; diagnosis ; surgery ; virology

OBJECTIVE: We conducted a pooled analysis of published studies to compare the performance of human papillomavirus (HPV) testing and cytology in detecting residual or recurrent diseases after treatment for cervical intraepithelial neoplasia grade 2 or 3 (CIN 2/3). METHODS: Source articles presenting data on posttreatment HPV testing were identified from the National Library of Medicine (PubMed) database. We included 5,319 cases from 33 articles published between 1996 and 2013. RESULTS: The pooled sensitivity of high-risk HPV testing (0.92; 95% confidence interval [CI], 0.90 to 0.94) for detecting posttreatment CIN 2 or worse (CIN 2+) was much higher than that of cytology (0.76; 95% CI, 0.71 to 0.80). Co-testing of HPV testing and cytology maximized the sensitivity (0.93; 95% CI, 0.87 to 0.96), while HPV genotyping (detection of the same genotype between pre- and posttreatments) did not improve the sensitivity (0.89; 95% CI, 0.82 to 0.94) compared with high-risk HPV testing alone. The specificity of high-risk HPV testing (0.83; 95% CI, 0.82 to 0.84) was similar to that of cytology (0.85; 95% CI, 0.84 to 0.87) and HPV genotyping (0.83; 95% CI, 0.81 to 0.85), while co-testing had reduced specificity (0.76; 95% CI, 0.75 to 0.78). For women with positive surgical margins, high-risk HPV testing provided remarkable risk discrimination between test-positives and test-negatives (absolute risk of residual CIN 2+ 74.4% [95% CI, 64.0 to 82.6] vs. 0.8% [95% CI, 0.15 to 4.6]; p<0.001). CONCLUSION: Our findings recommend the addition of high-risk HPV testing, either alone or in conjunction with cytology, to posttreatment surveillance strategies. HPV testing can identify populations at greatest risk of posttreatment CIN 2+ lesions, especially among women with positive section margins.
Cervical Intraepithelial Neoplasia/pathology/surgery/*virology ; Female ; Humans ; Neoplasm Recurrence, Local/*virology ; Neoplasm, Residual ; Papillomaviridae/*isolation & purification ; Papillomavirus Infections/complications/*diagnosis ; Predictive Value of Tests ; Risk Assessment/methods ; Sensitivity and Specificity ; Uterine Cervical Neoplasms/pathology/surgery/*virology

OBJECTIVE: To investigate the prevalence, etiology, clinical presentation and pathological features, treatment and prognosis of cervical cancer in young women. METHODS: Clinical data of 132 young women with cervical cancer were reviewed. RESULTS: Positive rate of human papillomavirus 18 was high in young women with cervical cancer. The primary clinical presentation of young patients with cervical cancer was contact bleeding of vagina, and the signs were out-expanding of cervical mass. The percentage of adenocarcinoma increased. The main treatment for cervical cancer was surgery. The patients had radical hysterectomy plus ovarian transplantation, none of whom had ovarian metastases and menopause syndrome. Prognosis of most patients was good. CONCLUSION Contact bleeding is a significant symptom in young women with cervical cancer. Surgery is first considered in the treatment. Preoperative neoadjuvant chemotherapy can be used in patients with locally advanced and late stage cervical cancer. Ovarian transplantation during operation can retain the ovary function.
Adult ; Age Factors ; Female ; Human papillomavirus 18 ; isolation & purification ; Humans ; Papillomavirus Infections ; complications ; Prognosis ; Uterine Cervical Neoplasms ; diagnosis ; surgery ; therapy ; virology ; Young Adult