Prognostic Factors of Human Papillomavirus Genotypes of Invasive Cervical Carcinoma: An Analytical Cross-Sectional Study in Lower North-East Thailand
Metee Wongsena MD**, Phalakorn Suebsamran MS*, Pawana Panomket PhD*, Sutthini Tirat MD*, Parichart Wongsena MD*, Surasak Wanram PhD*
Affiliation : * Clinical Research Unit, College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani, Thailand ** Obstetrics and Gynecology Unit, Ubon Ratchathani Cancer Hospital, Ubon Ratchathani, Thailand
Background : Cervical cancer (CXCA) caused by persistent infections by high-risk human papillomavirus (HR-HPV) can
lead to multi-step carcinogenesis. The best management strategy and significant prognosis for cervical cancer patients
remain unclear.
Objective : To investigate the associations of the two most common HR-HPVs with clinical outcomes of progression and
recurrence status as well as prognosis outcomes of patients.
Material and Method: An analytical cross-sectional study of patients registered at Ubon Ratchathani Cancer Hospital was
conducted from 2007 to 2010. Clinical data, histopathological features, and clinical outcomes of progression and recurrence
status were recorded. HPV type-specific E6/E7 nested multiplex polymerase chain reaction (NMPCR) was performed to
identify HR-HPV16 and 18 using extracted deoxyribonucleic acid (DNA) from embedded paraffin. Clinical findings and HPV
genotypes were analyzed using Fisher’s exact test. Association studies of crucial factors and HR-HPV genotypes were
performed using logistic regression analysis (odds ratio [OR]) and 95% confidence interval [CI]). A p-value of less than 0.05
was considered statistically significant.
Results : The study found single HPV16 infection in 57.3%, single HPV18 in 17.3%, mixed HR-HPV16/18 in 13.1%, and non-
HPV16, 18, or 16/18 in 12.3%. The findings showed significant association among their genotypes and histopathological
types and grading (p<0.0001 and p = 0.014). Clinical outcomes of progression and recurrence status with increased severity
of clinical staging were associated significantly (p = 0.001 and p = 0.002). HPV18 type-specific was shown as a poor
prognostic type with its relevance to the severity of disease higher than that of HPV16.
Conclusion and Discussion: HPV16 and 18 remain the major type-specifics especially in relation to invasive CXCA,
requiring further therapeutic vaccination study and proper prognosis. HR-HPV type-specific is very important during
cervical carcinogenesis but other crucial contributing factors for prognostic outcomes should be further elucidated.
Keywords : HPV16, HPV18, HPV16/18, Clinical outcomes of progression, Prognosis, Recurrence, Analytical cross-sectional study
