Analysis of clinical features and prognosis of HPV-negative endocervical adenocarcinoma

Abstract Objectives: To analyze the differences in clinical features and prognosis of HPV-negative and HPV-positive endocervical adenocarcinoma (ECA).Methods: The database of Qilu Hospital was searched for women with HPV testing who underwent primary surgery for ECA between January 2014 and December 2020. The clinical features of the two groups were compared, and the prognosis was evaluated by Kaplan–Meier survival curves. Moreover, immunohistochemical characteristics were reviewed in combination with literatures.Results: Among the 198 enrolled cases of ECA, 62 cases (31.31%) were HPV-negative ECA. Compared with HPV-positive ECA, HPV-negative ECA was more significantly associated with age, clinical symptoms, cervical cytology, CA125, FIGO stage, histologic subtypes, tumor diameter (<3 cm), deep stromal invasion (DSI), lymphovascular space invasion (LVSI), ovarian metastasis and intermediate-risk factors (all p<0.05). However, no significant differences were observed in the pregnancy and parturition times, CA19-9 level, CEA level or lymph node metastasis between the two groups (all p≥05). The OS of patients with HPV-negative ECA was poorer than that of those with HPV-positive ECA (p=0.00). Multivariable analysis showed that HPV-negative status, lymph node metastasis and DSI were significantly associated with the OS of ECA.Conclusions: HPV-negative ECA is characterized by older age, larger tumor, higher stage, susceptibility to LVSI, insensitivity to radiotherapy and chemotherapy and poor prognosis. Furthermore, lymph node metastasis and DSI can be used as predictors of prognosis in ECA. The diagnosis of HPV-negative ECA requires consideration of cervical cytology, colposcopy screening and clinical symptoms. And, biopsy plus immunohistochemistry can improve accuracy of diagnosis.