Epstein-Barr virus and its prognostic value in a cohort of Peruvian women with cervical cancer

Abstract

Aim: We aim to evaluate the prognostic effect of Epstein-Barr virus (EBV) infection on overall survival (OS) in Peruvian women with cervical cancer. Methods: We conducted a retrospective cohort study. Polymerase chain reaction technique was used in paraffin-embedded tumor tissue for the detection of EBNA-1 and LMP-1. We used a multiple Cox proportional-hazard regression to estimate adjusted hazard ratios (aHR) for death and 95% confidence intervals (95% CI). In order to model continuous variables without categorization, we used a multivariable fractional polynomial approach. We performed a stability analysis using bootstrapping for internal validation. Results: A total of 99 patients with cervical cancer were included. The prevalence of EBV in cervical cancer specimens was 22.2% (n=22). The 1-year and 5-year OS rates were 81.8% (95% CI 58.5-92.8) and 45% (95% CI 23.9-64.1) in the EBV-positive group compared to 78.8% (95% CI 67.7-86.4) and 37.8% (95% CI 25.7-49.8) in the EBV-negative group, respectively. In the multivariate analysis, positive EBV status was an independent prognostic factor for improved OS (aHR: 0.32; 95% CI 0.16 to 0.67; p=0.002) compared to negative EBV status. Conclusions: EBV status is an independent prognostic factor for OS in cervical cancer. Evaluation of EBV status could be used as a clinical prognostic biomarker and to improve currently available prognostic models such as the FIGO system. Future prospective studies will be needed to validate these theories.