Peritoneal HPV-DNA test in cervical cancer (PIONEER study): A proof of concept

Nicolò Bizzarri, Luigi Pedone Anchora, Paola Cattani, Rosa De Vincenzo, Simona Marchetti, Carmine Conte, Vito Chiantera, Valerio Gallotta, Salvatore Gueli Alletti, Giuseppe Vizzielli, Barbara Costantini, Anna Fagotti, Francesco Fanfani, Giovanni Scambia, Gabriella Ferrandina

Research output: Contribution to journalArticlepeer-review


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 March 2019 and April 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. Two-hundred seventy-two 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 cervical cancer (LACC) and 46.6% in the metastatic/persistent/recurrent setting (P =.001). No control patient was found to have peritoneal HPV infection. Higher frequency of PHP was documented in patients with larger tumor size (P =.003), presence of cervical HPV 16/18 genotypes (P <.001), higher number of cervical high-risk (HR)-HPV per patient (P =.018) and peritoneal carcinomatosis (P <.001). Multivariate analysis demonstrated that lack of preoperative cervical conization in early stages (P =.030), while higher International Federation of Gynecology and Obstetrics (FIGO) stage (P =.021) and presence of cervical HPV 16/18 (P =.001) in LACC, was associated with PHP. This is a proof-of-concept study. A number of potential clinical implications, including prognosis, could be obtained by further studies.

Original languageEnglish
Pages (from-to)1197-1207
Number of pages11
JournalInternational Journal of Cancer
Issue number5
Publication statusPublished - Mar 1 2021


  • cervical cancer
  • genotypes
  • HPV
  • infection
  • peritoneum
  • prognostic factors

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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