High-Risk HPV Confers Better Prognosis in Cervical Ca

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Offline Sabreena Chowdhury Raka

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High-Risk HPV Confers Better Prognosis in Cervical Ca
« on: November 15, 2018, 02:23:13 PM »
Presence of high-risk human papillomavirus (hrHPV) in women with invasive cervical cancer was associated with improved survival, a Swedish population-based cohort study found.

Women with hrHPV-positive tumors had a 39% lower excess mortality than women with hrHPV-negative tumors, reported Pär Sparen, PhD, of the Karolinska Institutet in Stockholm, and colleagues.

"The presence of hrHPV in invasive tumor tissue is thus a strong and yet routinely accessible prognostic biomarker for the prognosis of cervical cancer and could be a useful complement to the established prognostic tools currently in use," said Sparen, in a release accompanying the study.

While the role of hrHPV in the development of invasive cervical cancer is well-known, it is unclear how hrHPV in tumors actually relates to prognosis, the researchers noted in their study in PLOS Medicine.

They explained that they therefore wanted to look further into the relationship between the presence of hrHPV in tumors and survival rates for invasive cervical cancer.

For the investigation, the first nationwide, population-based study of hrHPV status and cervical cancer prognosis, the researchers noted, they identified 4,254 women with confirmed cases of invasive cervical cancer between the years 2002 and 2011. In addition, HPV data was collected from regional biobanks, with 2,845 women included.

These patients were prospectively followed from the date of cancer prognosis to either the end of 2015, death, or migration from Sweden.

Of the 2,845 cases, hrHPV was found in 2,293. Sparen and co-authors determined that compared with hrHPV-negative patients, hrHPV-positive patients were younger, more highly educated, and more likely to have cancer that was detected through screening.

The researchers found that relative survival was "considerably and constantly" higher for hrHPV-positive cases than for negative cases throughout the period of the study. Of the 1,131 deaths observed during the course of the study, 822 (36.3%) occurred among the hrHPV-positive cases compared with 309 (56.0%) among hrHPV-negative cases.

The mean follow-up time was 6.5 years for hrHPV-positive patients and 4.9 years for hrHPV-negative patients.

The relative 5-year survival rate for hrHPV-positive cases was 0.74 (95% CI 0.72-0.76) compared with 0.54 (95% CI 0.50-0.59) for hrHPV-negative patients, the researchers reported.

There was a statistically significant 39% lower excess mortality rate among hrHPV-positive patients compared with hrHPV-negative patients, even after controlling for factors such as patient age, cancer stage, education, and tumor histological type.

As for why the lack of detectable hrHPV in cervical cancer tumors indicates a much worse prognosis, the researchers offered several possibilities: It is possible that some invasive cervical cancer tumors accumulated genetic changes to such an extent that they may no longer need the continued presence of hrHPV to maintain malignancy; and it is also possible that some of these hrHPV-positive cases are more immunogenic, Sparen and colleagues noted.

Still, they said, the underlying biological mechanisms "are not known and should be further investigated ... However, the "findings are fully compatible with hrHPV being the cause of cervical cancer" and "that loss of hrHPV DNA in the resulting tumor appears to be of clinical importance and should not be ignored."

Asked for her perspective, Margaret Liang, MD, of the University of Alabama at Birmingham, who was not involved with the study, noted that the research was based on a nationwide population-based cohort and had "excellent follow-up data and consistent pathology review."

"We know that high-risk HPV is the underlying cause of the vast majority of cervical cancers," Liang told MedPage Today. "Studies evaluating high-risk HPV status from the tumor specimen, based on polymerase chain reaction as a potential biomarker to direct therapeutic decisions, could be an exciting avenue of future investigation."

Reference:https://www.medpagetoday.com/hematologyoncology/cervicalcancer/75631
Sabreena Chowdhury Raka
Assistant Professor
Department of Pharmacy
Faculty of Allied Health Sciences
Daffodil International University