Epstein-Barr virus and its prognostic value in a cohort of Peruvian women with cervical cancer

Aim: We aim to evaluate the prognostic effect of Epstein-Barr virus (EBV) infection on overall survival (OS) in Peruvian women with cervical cancer. Methods: We conducted a retrospective cohort study. Polymerase chain reaction technique was used in paraffin-embedded tumor tissue for the detection of EBNA-1 and LMP-1. We used a multiple Cox proportional-hazard regression to estimate adjusted hazard ratios (aHR) for death and 95% confidence intervals (95% CI). In order to model continuous variables without categorization, we used a multivariable fractional polynomial approach. We performed a stability analysis using bootstrapping for internal validation. Results: A total of 99 patients with cervical cancer were included. The prevalence of EBV in cervical cancer specimens was 22.2% (n=22). The 1-year and 5-year OS rates were 81.8% (95% CI 58.5-92.8) and 45% (95% CI 23.9-64.1) in the EBV-positive group compared to 78.8% (95% CI 67.7-86.4) and 37.8% (95% CI 25.7-49.8) in the EBV-negative group, respectively. In the multivariate analysis, positive EBV status was an independent prognostic factor for improved OS (aHR: 0.32; 95% CI 0.16 to 0.67; p=0.002) compared to negative EBV status. Conclusions: EBV status is an independent prognostic factor for OS in cervical cancer. Evaluation of EBV status could be used as a clinical prognostic biomarker and to improve currently available prognostic models such as the FIGO system. Future prospective studies will be needed to validate these theories. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was partly supported by the Instituto de Evaluacion de Tecnologias en Salud e Investigacion, IETSI, Peruvian Social Security (EsSalud) through the grant Kaelin 2018 Award with the resolution number: 071-IETSI-ESSALUD- 2018. The rest was supported by the Center of Precision Medicine at the Universidad de San Martin de Porres in Lima, Peru. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: We obtained the approval by the Institutional Review Board and Ethic Committee of the Hospital Nacional Edgardo Rebagliati Martins-EsSalud for the use of CC samples and data. This data was securely and anonymously stored. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The data supporting the findings of this study are available in the Research Unit of the Oncology Department of the Hospital Nacional Edgardo Rebagliati Martins computer files, but restrictions apply to the availability of these data, which were used under the current study license and are therefore not publicly available. However, the data are available to the authors upon reasonable request and with the permission of the Research Unit.