Prognosis of Human Papillomavirus-Negative Compared to Human Papillomavirus-Positive Cervical Cancer

Objectives: The aims of the study were to evaluate the prevalence and prognosis of human papillomavirus (HPV)-negative cervical cancer (CC) and to compare these to data for HPV-positive CC. Materials and Methods: This retrospective cohort study compared between HPV-negative CC and HPV-positive CC patients. Primary end points were disease-free survival and overall survival. Secondary end points were demographic and clinical variables including histological diagnosis, stage, and treatment. Results: Of 233 women with CC, 18 (8%) tested HPV-negative. During a median follow-up of 45 months, 33 (14%) recurrences and 41 (18%) deaths were observed. Eleven of the 18 women (61%) who tested HPV-negative and 41 of the 215 (19%) who tested HPV-positive had only adenocarcinoma (p <.001). In a multivariate logistic regression analysis, advanced age (p =.003) and primary treatment with chemotherapy and/or radiotherapy (p <.001) remained statistically significant for recurrence or mortality (disease-free survival). The factors associated with lower survival were advanced age (p =.008), higher stage at diagnosis (p <.001), and HPV negativity (p =.062). Median overall survival for HPV-positive CC was not reached, compared with 24 months for HPV-negative CC. Kaplan-Meier curves showed lower rates of disease-free survival (p =.008) and overall survival (p =.011), for women with HPV-negative compared with HPV-positive CC. Conclusions: The relatively poor prognosis of HPV-negative CC is important in light of its relatively high prevalence, which could increase proportionally to HPV-positive CC due to increased HPV screening and vaccination. Further studies are needed to confirm whether HPV status is truly an independent prognostic factor in CC.