早期宫颈腺癌组织中人乳头状瘤病毒基因型分布及其临床意义

Distribution of human papillomavirus genotypes in early-stadge cervical adenocarcinoma and its clinical significance

目的观察HPV基因型在早期宫颈腺癌中的分布，并探讨其临床意义。方法选择2000年6月至2010年5月在浙江大学医学院附属妇产科医院保存的101例早期宫颈腺癌石蜡标本，采用巢式PCR方法对宫颈腺癌组织进行高危型HPV基因型检测，并分析HPVl8基因型感染与临床病理和预后的关系。结果成功提取DNA的96例标本中，HPV阳性92例（95．8％），其中HPVl6阳性57例（59．4％），HPVl8阳性58例（60．4％）；HPV单一型别感染22例（22．9％），HPV双重型别感染31例（32．3％），HPV多重型别感染39例（40．6％），包含HPVl6、18型混合感染37例（38．5％）。HPVl8阳性与阴性者的淋巴转移、脉管内瘤栓分别为27．6％、7．9％和22．4％、7．9％，差异有统计学意义，P〈0．05。单因素分析发现手术切缘、宫旁组织浸润、淋巴转移以及HPVl8阳性与早期子宫颈腺癌患者的无瘤生存和总生存时间有关。但多因素分析发现淋巴结转移是早期子宫颈腺癌患者无瘤生存时间和总生存时间的独立预后因素，而宫旁组织浸润是早期子宫颈腺癌患者总生存时间的独立预后因素。结论早期宫颈腺癌组织中常见的HPV基因型为18、16，HPVl8感染与早期宫颈腺癌的淋巴转移、脉管内瘤栓有关，但与其无瘤生存时间和总生存时间无关。

Objective To explore the distribution of high-risk HPV-genotypes in early-stage cervical adenocarcinoma and understand the clinical significance of HPV genotyping. Methods From June 2000 to May 2010 ,a total of 101 paraffin surgical specimens of cervical adenocarcinoma were genotyped by nested polymerase chain reaction （nested PCR ）. The associations of HPV18 with clinicopathological parameters and survival were further analyzed. Results DNA extraction was successfully performed for 96 samples. The HPV-positive rate of early-stage cervical adenocarcinoma was 95.8% （92/96）. Two common HPV types were HPV16 （59.4%） and HPV18 （60.4%）. The prevalence rates of single, double and multiple HPV infections were 22.9%, 32. 3% and 40.6% respectively. The positive rates of lymph node metastasis and vascular involvement with HPV18 infection were 27. 6% and 22. 4% versus 7.9% and 7. 9% for those without HPV18 infection. Univariate analysis showed that positive surgical margin, uterine corpus invasion ,lymph node metastasis and HPV18 infection were the predictive factors for poor prognosis of patients with cervical adenocarcinoma~ Multivariate analysis revealed that lymph node metastasis was an independent prognostic factor for both disease-free and overall survivals. And uterine corpus invasion was an independent prognostic factor of overall survival for early-stage cervical adenocarcinoma patients. Conclusion HPV16 and HPV18 are major types responsible for early-stage cervical adenocarcinoma. Infection with HPV18 is prone to lymph node metastasis and vascular involvement. However, there is no correlation with disease-free survival or overall survival.