Invasive Cervical Cancer Prognosis According to High-Risk HPV Status

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In a Swedish study reported in the Journal of Clinical Oncology, Lei et al found that patients with invasive cervical cancer and undetectable human papillomavirus (HPV) or infection with low-risk HPV types alone have poorer survival vs those with disease associated with high-risk HPV types.

Study Details

The study involved HPV testing of samples from all cervical cancers occurring during a 10-year period (2002–2011) in Sweden. Retesting of 392 of 2,845 invasive cervical cancer cases that were polymerase chain reaction–negative for HPV with RNA sequencing on the NovaSeq 6000 platform identified an additional 169 cases as HPV-positive. Patients were followed from date of diagnosis to the end of December 2016, with the main outcome measure being all-cause mortality.

Patients were categorized as high-risk HPV–positive if they had infection with any of the 13 most oncogenic HPV types (hrHPV-positive; n = 2,524) or hrHPV-negative if they had no detectable HPV or were positive for only low-risk HPV types (n = 321). Relative survival ratios (RSRs) were calculated vs the female general population. Models for excess hazard ratios were adjusted for age, time since diagnosis, stage, histology, and education level.

Key Findings

Compared with the female general population, cumulative relative survival for hrHPV-positive cases was consistently higher vs hrHPV-negative cases over a period of 15 years since diagnosis.

Compared with the female general population, the 5-year cumulative RSR was 0.45 (95% confidence interval [CI] = 0.39–0.51) in the hrHPV-negative group vs 0.74 (95% CI = 0.72–0.75) in the hrHPV-positive group. In adjusted analysis, the excess hazard ratio for death for the hrHPV-positive group vs the hrHPV-negative group was 0.57 (95% CI = 0.48–0.69), representing 43% lower excess mortality in the hrHPV-positive group.

Within the hrHPV-positive group, the excess hazard ratio for HPV18-positive cases vs HPV16-positive cases with single HPV type infection was 1.55 (95% CI = 1.23–1.94), representing a 55% increase in excess mortality for HPV18-positive cases.

The investigators concluded, “hrHPV status is a strong determinant of cervical cancer prognosis over 15 years after diagnosis, above and beyond other established factors.”

Karin Sundström, MD, PhD, of Department of Laboratory Medicine, Karolinska Institutet, and Center for Cervical Cancer Prevention, Karolinska University Hospital, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the Center for Innovative Medicine (CIMED), Clas Groschinsky Memorial Foundation, Swedish Medical Society, and others. For full disclosures of the study authors, visit

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