Human Papillomavirus and Management of Cervical Cancer: Does Genotype Matter

Human papillomavirus (HPV) infection has been established as an etiologic agent for cervical carcinoma (CC). Optimalmanagement of CC depends on precise tumor staging and thorough evaluation of tumor characteristics. HPV-18 is a predictor of poor prognosis in stage I-IIA CC patients receiving primary surgery, while alpha 7-related HPVs are predictors of poor outcomes in locally advanced CC. A high-risk group defined by preoperative variables including HPV-18 positivity is associated with a high probability of postoperative radiotherapy or concurrent chemoradiation (RT/CCRT). Additional HPV genotyping can help to select appropriate patients for primary radical hysterectomy. HPV-16 negativity indicates poor prognosis in cervical adeno-adenosquamous carcinoma (AD/ASC), especially for those treated with primary RT/ CCRT. Patients with HPV-16-negative AD/ASCs might better be treated with primary surgery (e.g., primary radical hysterectomy for stage I-II and pelvic exenteration for stage IVA). Multi-country and multi-center studies are necessary to verify the findings.