Peritoneal Hpv-Dna Test In Cervical Cancer (Pioneer Study): A Proof Of Concept

The aim of this study was to investigate the prevalence of peritoneal Human Papillomavirus (HPV) infection in different clinical cervical cancer (CC) settings, and its association with potential clinical and/or histological factors. This is a single-center, prospective, observational study. Consecutive patients with newly diagnosed or recurrent/persistent CC, between 03/2019 and 04/2020, were included. A group of patients undergoing surgery for benign gynecological conditions was included as control group. All patients underwent HPV-DNA test in the cervix and in the peritoneal cavity simultaneously at time of surgery. 272 patients had cervical and peritoneal HPV-test analyzed. Cervical and peritoneal HPV positivity (PHP) was found in 235 (88.0%) and 78 (28.7%) patients, respectively; the prevalence of PHP was 17.7% in early-stage, 28.8% in locally-advanced (LACC), and 46.6% in the metastatic/persistent/recurrent setting (p=0.001). No control patient was found to have peritoneal HPV infection. Higher frequency of PHP was documented in patients with larger tumor size (p=0.003), presence of cervical HPV 16/18 genotypes (p<0.001), higher number of cervical high-risk (HR)-HPV per patient (p=0.018) and peritoneal carcinomatosis (p<0.001). Multivariate analysis demonstrated that lack of pre-operative cervical conization in early stages (p=0.030), while higher FIGO-stage (p=0.021) and presence of cervical HPV 16/18 (p=0.001) in LACC, were associated with PHP. This is a proof of concept study. A number of potential clinical implications, including prognosis, could be obtained by further studies.