The prognostic value of different HPV infection statuses in cervical cancer

To compare oncological outcomes between HPV-positive and HPV-negative cervical cancer patients in a large Chinese multicenter cohort. This retrospective study included cervical squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma. Propensity score matching (PSM, 2:1) was used to balance baseline characteristics. Kaplan-Meier method and Cox proportional hazards regression were applied to compare 5-year overall survival (OS) and disease-free survival (DFS). The proportional hazards assumption was tested. Multicenter heterogeneity was adjusted using center stratification. Missing data were managed by complete-case analysis and multiple imputation sensitivity analysis. A total of 11,215 eligible patients were included. Before PSM, the HPV-positive group showed significantly better 5-year OS (92.3% vs. 84.3%, P < 0.001) and DFS (88.0% vs. 79.6%, P < 0.001) than the HPV-negative group. Multivariable Cox analysis confirmed HPV negativity as an independent risk factor for OS (HR = 1.545, 95%CI 1.091-2.188, P = 0.014) and DFS (HR = 1.556, 95%CI 1.212-1.997, P < 0.001). After 2:1PSM, HPV-positive patients still had superior 5-year OS (88.4% vs. 84.3%, P = 0.004) and DFS (85.3% vs. 79.6%, P < 0.001). Among 7,998 patients who underwent radical surgery, similar results were observed before and after PSM. HPV-negative status is associated with inferior 5-year OS and DFS and serves as an independent adverse prognostic factor in cervical cancer, including patients treated with radical surgery.