Abstract：
We aimed to investigate human papillomavirus (HPV) prevalence and genotype distribution and prognostic factors in vaginal cancer (VC). VC patients who received treatment between 1989 and 2020 were retrospectively reviewed. L1 general polymerase chain reaction (PCR) followed by HPV Blot (King Car, I-Lan, Taiwan) and E6 type-specific-PCR were performed for genotyping firstly. P16 and p53 immunohistochemistry staining was performed. Univariate and multivariate analyses identified predictors of clinical outcomes.79 VC patients were eligible for analysis. 73 patients (92.4%) were squamous cell carcinoma (SCC) and 6 (7.6%) as non-SCC. The median follow-up time was 134.3 months (range 0.9-273.4). Among nine initially HPV-negative cases, seven were identified as being positive through HPV16/18/45/52/58 whole-genome amplification followed by Sanger sequencing (WGASS). HPV DNA sequences were detected in 98.6% of SCC and 83.3% of non-SCC, respectively, with HPV16 (49.4%), HPV52 (15.2%) and HPV58 (8.9%) being predominant. Patients with paraaortic lymph node (LN) metastasis had a 5-year cancer-specific survival (CSS) rate of 0%. Multivariate analysis revealed that only p16 and stage were significantly correlated with prognosis. Variables with strong correlations (p16- and HPV-positivity, LN metastasis and stage), were included in models 2-5 alternatively. Stage III/IV (hazard ratio [HR] = 3.64-4.56) and LN metastasis (HR = 2.81-3.44) were significant negative predictors of CSS, whereas p16-positivity (HR = 0.29-0.32) and HPV-positivity (HR = 0.14) were related to better prognosis. In conclusion, 97.5% of VCs were HPV-positive with WGASS. Stage III/IV and LN metastasis were significant negative predictors, whereas p16- and HPV-positivity were significantly associated with better prognosis.
摘要：
我们旨在调查人乳头瘤病毒（HPV）的患病率和基因型分布以及阴道癌（VC）的预后因素。对1989年至2020年接受治疗的VC患者进行回顾性分析。L1一般聚合酶链反应(PCR)，然后进行HPV印迹(KingCar，I-Lan,台湾）和E6型特异性PCR首先进行基因分型。进行P16和p53免疫组织化学染色。单变量和多变量分析确定了临床结果的预测因子。79例VC患者符合分析条件。73例（92.4％）为鳞状细胞癌（SCC），6例（7.6％）为非SCC。中位随访时间为134.3个月（范围0.9-273.4）。在9例最初HPV阴性病例中，通过HPV16/18/45/52/58全基因组扩增，随后进行Sanger测序（WGASS），发现7例阳性。在98.6%的SCC和83.3%的非SCC中检测到HPVDNA序列,分别,HPV16（49.4%），以HPV52（15.2%）和HPV58（8.9%）为主。主动脉旁淋巴结（LN）转移患者的5年癌症特异性生存率（CSS）为0％。多因素分析显示，只有p16和分期与预后显着相关。具有强相关性的变量(p16和HPV阳性，LN转移和分期)，被包括在模型2-5中。III/IV期（风险比[HR]=3.64-4.56）和LN转移（HR=2.81-3.44）是CSS的显着负预测因子，而p16阳性(HR=0.29-0.32)和HPV阳性(HR=0.14)与更好的预后相关.总之,97.5%的VC为WGASSHPV阳性。III/IV期和LN转移是显著的阴性预测因子，而p16和HPV阳性与更好的预后显著相关.
