Recently, a team led by Wang Qing and Ding Jingxin from the Obstetrics and Gynecology Hospital affiliated with Fudan University published a study titled " Factors associated with the persistence of human papillomavirus after surgery in patients with cervical cancer". The study investigates the rate of human papillomavirus (HPV) persistence after surgery in patients with cervical cancer and analyzes the factors associated with HPV persistence and viral load after surgery.

• Conclusions

Postmenopausal patients and those with positive vaginal incision margin with cancer are at an increased risk of HPV persistence after surgical treatment for cervical cancer. Vaginal lesions with cancer or SILs and positive vaginal incision margin are risk factors for high HPV viral load after surgery.

• Methods

Medical records of women who underwent surgery for treatment of cervical cancer between 1 January 2018 and 30 June 2019 at Obstetrics and Gynecology Hospital of Fudan University in Shanghai, China, were retrospectively analyzed. Patients with persistent HPV infection after 2 years of follow-up were identified. Univariate and multivariate analyses were employed to determine the impact of various factors including patient age, menopausal status, parity, and surgical margin status on HPV persistence. The Wilcoxon test was used to analyze the factors that influenced postoperative HPV viral load.

• Results

01. Patient characteristics

607 patients were included in this retrospective analysis. The median age was 47 years (40–54 years). The most common histological type was SCC (81.9 %) followed by adenocarcinoma (12.9 %), mucinous adenocarcinoma (2.1 %), adenosquamous carcinoma (2.1%), and basal cell carcinoma (0.3 %). Of the 607 patients, 208 patients (34.3 %) were menopausal women, three patients (0.5 %) had a smoking habit, the vaginal incision margin of 22 patients (3.6 %) had cancer cells, three patients (0.5 %) had low-grade SIL (LSIL), and seven patients (1.2 %) had high-grade SIL (HSIL).

02. HPV persistence rate and genotypes

All patients were HPV-positive before surgery. The postoperative HPV status was analyzed at 6 months, 1 year, and 2 years after treatment. Among the 607 patients, HPV infections were detected in 105 patients at 6 months, 83 patients at 1 year, and 62 patients at 2 years after surgery. The persistence rates of HPV at 6 months, 1 year, and 2 years after surgery were 17.3, 13.7, and 10.2 %, respectively. Of the 105 HPV-positive patients at 6 months, the main HPV genotypes were HPV 16 (12.38 %), HPV 18 (1.90 %), HPV 52 (13.33 %), HPV 33 (4.76 %), HPV 53 (8.57 %), HPV 58 (3.81 %), and 12 other non-specified HPV genotypes (43.81 %). Of the 83 HPV-positive patients at 1 year, the main HPV genotypes were HPV 16 (11.69 %), HPV 18 (2.60 %), HPV 52 (11.69 %), HPV 33 (5.19 %), HPV 53 (7.79 %), HPV 58 (5.19 %), and 12 other non-specified HPV genotypes (46.75 %).

03. Univariate and multivariate analyses

Univariate analysis revealed that old age, menopause, and vaginal incision margin with cancer influenced HPV clearance at 6 months, 1 year, and 2 years after surgery. The mean age of women with persistent HPV infection was higher than that of women without persistent HPV infection. Menopausal status and vaginal incision margin with cancer were significant independent predictors of HPV persistence at 6 months, 1 year, and 2 years after surgery.

04. Influencing factors of postoperative HPV viral load

This study used the Wilcoxon test to analyze the factors influencing the postoperative HPV viral load. The results demonstrated that vaginal lesions with cancer or SILs and positive vaginal incision margin influenced the viral load at 6 months after surgery. Moreover, they were considered risk factors for high viral load at 6 months after surgery.

The present study confirmed the significance of menopausal status and positive surgical margin with cancer as risk factors for HPV persistence after surgery for cervical cancer. Moreover, vaginal lesions with cancer or SILs and positive vaginal incision margin were identified as risk factors for high viral load after surgery for cervical cancer. The significance of this study lies in its potential to help in the early identification of patients who may have persistent HPV infection during the follow-up process of cervical cancer surgery and cause clinicians to pay attention to this part of patients. Corresponding intervention measures like menopausal hormone therapy can be implemented to address these high-risk factors, thereby reducing the HPV infection rate and viral load and providing primary prevention for postoperative vaginal lesions and even tumors in patients with cervical cancer.

Reference:

Wang Q, Zhou FY, Ding JX. Factors associated with the persistence of human papillomavirus after surgery in patients with cervical cancer. Diagn Microbiol Infect Dis. 2024 Apr;108(4):116201. doi: 10.1016/j.diagmicrobio.2024.116201. Epub 2024 Jan 30. PMID: 38340484.