Analysis of risk factors for progression and prognosis of survival in HPV-associated cervical cancer: a retrospective study

Background. Among the most significant risk factors for the development of cervical cancer is human papillomavirus (HPV) infection. Stratifying patients by risk of progression is essential for a differentiated approach to cervical cancer treatment. There are currently insufficient studies examining the relationship between HPV-associated cervical cancer and risk factors for progression to assess survival prognosis. Aims — to assess the role of HPV infection in the formation of postoperative risk factors for progression and survival prognosis in patients with cervical cancer. Methods. A retrospective study was conducted involving 194 patients with stage I–II cervical cancer (TNM) after radical hysterectomy according to Wertheim with a course of radiation therapy at the Republican Oncology Center named after prof. G.V. Bondar of the Ministry of Health of the Donetsk People’s Republic from 2014 to 2022. PCR testing was used to form groups with HPV-positive and HPV-negative status. A comparative analysis of differences in the frequencies of data between the groups, such as age, cervical cancer stage, size, histological type and degree of differentiation of the tumor, LVSI, and depth of stromal invasion (DSI), was performed using the χ² criterion. The association of HPV status with overall survival (OS) and relapse-free survival (RFS) was estimated using the Kaplan-Meier method. To study the influence of risk factors on survival rates in the HPV-positive group, univariate and multivariate analysis of the Cox proportional hazards regression model was used. Results. HPV-positive status was determined in 118 patients (60.82%), HPV-negative status in 76 (39.18%). In HPV infection, the number of patients with moderate tumor differentiation prevailed (p = 0.003). LVSI (p = 0.045), with DSI more than 1/3 of the cervical myometrial thickness (p = 0.006), with a tumor size of > 4 cm (p = 0.027). The 5-year OS rates with HPV-positive status and HPV-negative status were 92.37 and 98.68% (p = 0.027), 5-year RFS — 83.05 and 98.68% (p = 0.0001). In multivariate analysis, the significant factor for OS was the histological type of adenocarcinoma (p = 0.008), for RFS – adenocarcinoma (p = 0.031) and the degree of moderate differentiation (p = 0.013) and GSI > 1/3 of the myometrial wall (p = 0.013). Conclusions. An association between HPV infection in cervical cancer and decreased OS and RFS has been established. Significant prognostic factors associated with an increased risk of recurrence in cervical cancer included the histological type of adenocarcinoma, the degree of moderate differentiation, and a GSI greater than one-third of the cervical wall thickness. The results of clinical and pathological parameters in cervical cancer are important for risk stratification and treatment strategies.