HPV detectability linked to better cervical cancer prognoses

Key takeaways:

• Testing positive for HPV was associated with better disease-free survival, cancer-specific survival and overall survival.
• A positive HPV test was not associated with cervical cancer recurrence.

HPV detectability was associated with better clinical cervical cancer prognosis vs. no detectable virus with up to a 41% lower mortality risk, according to a systematic review and meta-analysis published in Obstetrics & Gynecology.

“There are several factors, such as access to treatment, stage at diagnosis and more, that are related to cervical cancer prognosis,” Karena D. Volesky-Avellaneda, PhD, postdoctoral fellow in the division of cancer epidemiology and the department of epidemiology, biostatistics and occupational health at McGill University in Montreal, told Healio. “Identifying additional factors that can influence the course of cervical cancer, like HPV detectability, could be helpful in improving prognostic outcomes for this cancer.”

Volesky-Avellaneda and colleagues conducted a systematic review and meta-analysis identifying 77 studies from Embase and MEDLINE that assessed HPV DNA or RNA in cervical pretreatment biopsies or cells from at least 20 women with invasive cervical cancer. Researchers assessed any associations between testing positive or negative for HPV and cancer recurrence, disease-free survival, cancer-specific survival or overall survival.

Overall, 30 studies reported the relation of HPV status to histology, 39 reported its relation to cancer stage, 13 reported its relation to tumor grade, 17 reported its relation to tumor size, 23 reported its relation to lymph node involvement and four reported its relation to treatment response.

Testing positive for HPV was not associated with cervical cancer recurrence (HR = 0.59; 95% CI, 0.33-1.07), but was associated with:

• better disease-free survival (HR = 0.38; 95% CI, 0.25-0.57);
• cancer-specific survival (HR = 0.56; 95% CI, 0.44-0.71); and
• overall survival (HR = 0.59; 95% CI, 0.47-0.74).

When pooling studies, researchers observed a 41% lower mortality risk among those with cervical cancer who tested positive for HPV compared with those who tested negative. Researchers also noted that the number of cases, tumor grade, specimen type, gene target and HPV prevalence together could explain 73.8% of the between-study heterogeneity observed.

“We need to understand why cervical cancer patients with detectible HPV have better survival outcomes. There are many possible explanations, but the specific reasons are not yet established. We aimed to find out whether detectible HPV was associated with better prognosis, and to do this we examined several prognostic outcomes and found that yes, in fact, detectible HPV is associated with better cervical cancer prognosis,” Volesky-Avellaneda said. “Next steps are to figure out why that is. For example, is it because HPV detectability could be related to tumor grade?”

For more information:

Karena D. Volesky-Avellaneda, PhD, can be reached at diana.volesky@nih.gov.