Prognostic implication of human papillomavirus types in cervical cancer patients: a systematic review and meta-analysis

BACKGROUND To estimate the prognostic relevance of human papillomavirus (HPV) 16 and HPV 18 in patients with cervical cancer. METHOD We searched PubMed, EMBASE, American Society of Clinical Oncology (ASCO) and the European Society of Medical Oncology (ESMO), CNKI, and Wanfang databases to search primary articles illustrating the survival outcomes in cervical cancer patients with or without HPV 16/18 infection. A meta-analysis was conducted to generate a combined hazard ratio (HR) with 95% confidence intervals (CI) for progression-free survival (PFS), disease free survival (DFS) and overall survival (OS). RESULTS A total of 13 studies were included. Our meta-analysis revealed that HPV 16 positive did not have any impact on OS (HR, 0.76; 95% CI = 0.37-1.54; P = 0.44). Cervical cancer patiensts infected with HPV 18 had worse OS (HR, 1.66; 95% CI = 1.28-2.17; P = 0.0001), DFS (HR, 2.10; 95% CI = 1.73-2.54; P < 0.0001) and worse PFS (HR, 2.97; 95% CI = 1.69-5.23; P = 0.00012) compared with those not infected with HPV 18. cervical cancer patiensts infected with HPV 18 had worse PFS compared with those infected with HPV 16 ((HR, 1.34; 95% CI = 1.06-1.70; P = 0.01). CONCLUSION Cervical cancer patients infected with HPV 18 had worse survival compared with cervical cancer patients with HPV 16 infection.