The Role of High-Risk Human Papilloma Virus Testing in the Surveillance of Cervical Cancer After Treatment

Abstract

Context.-Cervical cancer affects 12 000 women in the United States annually. However, despite its prevalence, there remains no good methodology to detect its recurrence.Objective.-To identify the role of cervicovaginal highrisk human papilloma virus (hr-HPV) testing in predicting cervical cancer recurrence.Design.-This is a retrospective study of patients who underwent hr-HPV testing as part of their routine surveillance for cervical cancer. Standard statistical analyses, including v 2 test and multivariable logistic regression, were performed with IBM SPSS 19.0.Results.-A total of 133 patients were identified, of whom 107 (80%) had squamous cell carcinoma. Ninety patients (68%) had bulky disease and were treated primarily with chemoradiation and brachytherapy. Of patients whose disease recurred, 5 patients (42%) had tested positive for hr-HPV during their surveillance period, compared to 13 patients (11%) for whom disease did not recur (relative risk: 3.88, P ¼ .002). On multivariate logistic regression, hr-HPV status remained significantly predictive of disease recurrence (odds ratio: 12.3, P ¼ .02, 95% confidence interval: 1.5-99.6). Using 2 3 2 table analysis, we found that while cervicovaginal cytology has limited specificity (5.7%) in predicting recurrence, the combination of cytology with hr-HPV testing increases the specificity of testing to 89.3%.Conclusions.-Persistence of hr-HPV is a risk factor for disease recurrence. High-risk-HPV testing is not routinely used during surveillance for cervical cancer, but this study suggests that large, prospective trials investigating the role of hr-HPV testing in cervical cancer surveillance are needed.

Diagnostic Strategies for Recurrent Cervical Cancer: A Cohort Study

“…In addition, every 12 months, a secondary imaging assessment, including computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography-computed tomography (PET-CT), was performed according to the preference of the patient and the potential necessity for disease evaluation. hrHPV genotyping is not compulsory at the study center and was not included in the analysis due to its uncertainty in detecting cancer recurrence, according to our experience and relevant reports ( 19 ).…”

PSMD9 expression correlates with recurrence after radiotherapy in patients with cervical cancer

“…Song and colleagues found the same in a bigger cohort of cervical cancer patients of 156 patients (21). Yu and colleagues advise to perform HPV tests after cervical cancer treatment, since they found a significant higher risk for recurrence in patients with high-risk HPV infection after therapy (22). Deng and colleagues tested the viral load in 246 patients before cervical cancer therapy with radical hysterectomy.…”

Detecção de DNA de HPV no plasma para potencial identificação precoce de recidiva de câncer do colo de útero

“…Yu et al (61) encontraram uma taxa de recidiva de 9% (12/133) das pacientes tratadas por câncer cervical no perído de seguimento que durou uma média de 26,6 meses.…”

“…Os testes utilizados para seguimento de pacientes submetidas a tratamento contra câncer cervical são: exame físico (inspeção visual ou relato das pacientes), raios-X de tórax, teste de Papanicolaou (teste citológico), tomografia computadorizada (CT scan), ressonância magnética, ultrassom e testes moleculares (6,7,65,66) . Porém, ainda não há uma boa metodologia estabelecida para a detecção da recidiva de câncer cervical (61) .…”

“…Yu e cols. (61) sugerem que a persistência de HPV de alto-risco no seguimento seja um fator de risco para recidiva da doença (61) .…”