Prognostic value of HPV-mRNA in sentinel lymph nodes of cervical cancer patients with pN0-status

• Published in: Oncotarget 2015-09, Vol.6 (26), p.23015-23025
• Main Authors: Dürst, Matthias, Hoyer, Heike, Altgassen, Christoph, Greinke, Christiane, Häfner, Norman, Fishta, Alba, Gajda, Mieczyslaw, Mahnert, Ute, Hillemanns, Peter, Dimpfl, Thomas, Lenhard, Miriam, Petry, K Ulrich, Runnebaum, Ingo B, Schneider, Achim
• Format: Article
• Language: English
• Subjects: Adult; Aged; Clinical Research Paper; Female; Humans; Lymph Nodes - pathology; Lymph Nodes - virology; Middle Aged; Papillomaviridae - genetics; Papillomaviridae - isolation & purification; Prognosis; Prospective Studies; RNA, Messenger - genetics; RNA, Viral - genetics; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - virology; Young Adult
• ISSN: 1949-2553; 1949-2553
• DOI: 10.18632/oncotarget.4132

Up to 15% of patients with cervical cancer and pN0-status develop recurrent-disease. This may be due to occult metastatic spread of tumor cells. We evaluated the use of human-papillomavirus-(HPV)-mRNA as a molecular marker for disseminated tumor cells to predict the risk of recurrence. For this prospective, multi-center prognostic study, 189 patients free of lymphnode metastases by conventional histopathology could be analyzed. All patients underwent complete lymphadenectomy. Of each sentinel node (SLN) a biopsy was taken for the detection of HPV-E6-E7-mRNA. Median follow-up time after surgery was 8.1 years. HPV-mRNA could be detected in SLN of 52 patients (27.5%). Recurrence was observed in 22 patients. Recurrence-free-survival was significantly longer for patients with HPV-negative SLN (log rank p = 0.002). By Cox regression analysis the hazard ratio (95%CI) for disease-recurrence was 3.8 (1.5 - 9.3, p = 0.004) for HPV-mRNA-positive compared to HPV-mRNA-negative patients. After adjustment for tumor size as the most influential covariate the HR was still 2.8 (1.1 - 7.0, p = 0.030). In patients with cervical cancer and tumor-free lymph nodes by conventional histopathology HPV-mRNA-positive SLN were of prognostic value independent of tumor size. Particularly, patients with tumors larger than 20mm diameter could possibly benefit from further risk stratification using HPV-mRNA as a molecular marker.