Skip to main content

Clinical analysis of 312 patients with stage IB1-IIA2 cervical squamous cell carcinoma and research on the influencing factors of postoperative recurrence



To investigate the influencing factors of the recurrence of IB1-IIA2 cervical squamous cell carcinoma after surgical treatment, and to explore the relationship between high-risk human papillomavirus (HR-HPV) infection and postoperative cervical squamous cell carcinoma recurrence.


Patients (n = 312) diagnosed with stage IB1-IIA2 cervical cancer and treated by radical hysterectomy and lymphadenectomy at this hospital were accrued between January 2014 and December 2016. The clinical data of these patients were analysed, and the association among clinicopathological factors, the association among clinicopathological factors, HPV infection and recurrences was investigated through Cox regression.


The median follow-up time was 59.2 months (with a range of 14–77.9 months). The pre-operative HPV infection rate was 85.3% (266/312), and 74 patients had a high level of HPV-DNA (> 5 × 106 copy number / 104 cells). Twenty-nine patients had a postoperative persistent high level of HPV-DNA (9.3%). On multivariate analysis, deep 1/3 stromal invasion (hazard ratio [HR] 114.79, 95% confidence interval [CI] 2.821–4670.111, p = 0.012*) and postoperative persistence of high HPV-DNA levels within 12 months (HR 269.044, 95% CI 14.437–5013.754, p < 0.001*) and 24 months (HR 31.299, 95% CI 1.191–822.215, p = 0.039*) were associated with a higher local recurrence rate.


Continuous high HPV-DNA levels within 24 months of an operation and deep 1/3 interstitial infiltration were independent risk factors for local recurrences of cervical cancer.


  1. 1.

    The relationship between postoperative HPV infection and cervical cancer recurrences was explored for the first time.

  2. 2.

    The genotypes and viral loads of 15 types of HR-HPV were determined.

  3. 3.

    Continuous HR-HPV positivity after surgery and deep 1/3 interstitial infiltration were risk factors for the recurrence of cervical cancer.

Peer Review reports


Cervical cancer is the fourth most common cancer among women worldwide. In 2018, there were an estimated 570,000 new cases and 311,000 deaths worldwide, including 106,000 cases and 48,000 deaths in China alone [1]. China’s contribution to the global total amounted to 18.6% of new cases and 15.4% of deaths [2]. The cervical cancer screening strategy is based on the human papillomavirus (HPV) test and the Papanicolaou test [3]. Postoperative recurrence is the main cause of death in patients with cervical cancer. Studies show that the recurrence rate of cervical cancer five years after surgery can be as high as 13.40% [4]. Despite a decrease in cervical cancer occurrences in developed countries due to screening programs, the frequency of this disease in developing nations continues to increase at an alarming rate, at least partly due to insufficient HPV screening and follow-up [5]. Strict postoperative follow-up and early warnings are important to prevent the recurrence of cervical cancer after surgery.

A high-risk HPV (HR-HPV) infection is closely related to cervical cancer and its precancerous lesions, namely cervical intraepithelial neoplasia (CIN). Its sensitivity and negative predictive value in diagnosing cervical lesions can even be as high as 100%. Therefore, HR-HPV detection is currently attracting much attention in cervical lesion screenings [6]. There are significant differences in clinical treatment strategies and prognoses among patients with different degrees of CIN. Finding sensitive indicators that can reflect the degree of CIN and prognosis is the focus of clinical attention [7]. Tumour size, stromal invasion, lymphovascular space involvement (LVSI), pathologically confirmed lymph node metastases, extensions into parametrial tissue and positive surgical margins are predictors of recurrence after primary surgery [8]. Some studies suggest that the HPV viral load is closely related to the degree of CIN [9]. Moreover, research by Yu et al. [10] found that the HPV viral load can be at a low level in patients with cervical cancer but at a high level in chronic cervicitis and even among healthy women. In addition, there are few research reports on the relationship between HR-HPV viral loads and the clinical outcomes of patients with CIN. It is still controversial whether an HR-HPV viral load can be used as the evaluation standard of the pathological degree and prognosis of clinical CIN [11], particularly the postoperative HPV viral load.

In this study, the clinical data and outcomes of 312 patients with stage IB1-IIA2 cervical squamous cell carcinoma who underwent surgical treatment were analysed, and the potential influencing factors affecting postoperative recurrence were studied to provide a new perspective for evaluating the risk of recurrence.

Materials and methods

Patient characteristics

Data on patients with stage IB1-IIA2 [12] cervical cancer treated in this hospital from January 2014 to December 2016 were analysed retrospectively. The inclusion criteria included the following: (1) patients were treated by radical hysterectomy (RH) with pelvic ± para-aortic lymphadenectomy; (2) they accepted pre- and postoperative HPV tests by an HPV real-time polymerase chain reaction (qRT-PCR) kit (Z-ME-0100-50, Liferiver, Shanghai, China); (3) patients had squamous cell carcinoma; (4) they had normal mental cognition; (5) they provided complete follow-up data for at least 14 months. The exclusion criteria were as follows: (1) patients had comorbidity with malignant tumours in other parts of the body, severe organ dysfunction or immune system diseases; (2) they had received drug treatment or chemoradiotherapy before enrolment; (3) they had a previous history of cervical or uterine surgery or HPV vaccination; (4) pregnant or lactating women; (5) the follow-up was not completed as required, or the follow-up data were incomplete. This study was conducted following the Declaration of Helsinki (2013) and approved by the Ethics Committee of the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.

Treatment and follow-up

Radical hysterectomy with pelvic node dissection are the primary methods of treatment for patients with early-stage cervical cancer. The present investigation highlighted that in referral centres, the shift from minimally invasive to open RH did not influence 90-day surgery-related morbidity [13, 14]. All patients were treated by RH and pelvic ± para-aortic lymphadenectomy, including laparotomy and laparoscopy. The ipsilateral or bilateral ovaries were preserved for patients younger than 45 years old. Patients with LVSI, a positive surgical margin, stromal invasion or lymph node metastasis received either adjuvant radio/chemotherapy or concurrent radio/chemotherapy (CCRT). The total dosage of radiotherapy was 45–50 Gy of cisplatin (40 mg/m2), which was administered during CCRT on a weekly basis. The volume of external beam radiotherapy covered the region of the previous gross disease, parametrial space, uterosacral ligaments, three centimeters of tissue at the proximal end of the vagina and all pelvic nodal volumes at risk. The follow-up period was the duration from the date of the surgical operation to either the end of 30 December 2020 or the date of recurrence.

Data collection

The data of all patients were retrospectively collected, including pre-diagnosis, the degree of the disease, the treatment methods adopted and postoperative follow-up.

Human papillomavirus-deoxyribonucleic acid testing

All patients consented to receiving the HPV-deoxyribonucleic acid (DNA) test within one month pre-operatively and at multiple time points during the postoperative follow‐up period. The patients were instructed to avoid vaginal douching three days before the examination, abstain from sex the day before and avoid having the examination during their menstrual period. Patients were placed into the lithotomy position during the examination, and after the cervix was exposed, it was beneficial for the special collector to enter the cervix for sampling. The brush was placed in the cervix, rotated clockwise for three to five times, placed in a special storage bottle, sealed and sent for inspection. ThinPrep cytology specimens were tested by the HPV qRT-PCR kit (Z-ME-0100-50, Liferiver, Shanghai, China), which detects viral DNA by nucleic acid hybridisation with a pooled probe set for 15 HR-HPV genotypes (HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 and 82). The nucleic acid was extracted by an automatic nucleic acid extracting machine (Autrax Bio-system®, Liferiver, Shanghai, China). All PCR were performed by a qRT-PCR thermocycler (SLAN-96P real-time PCR system, Shanghai Hongshi Corp, China) with a detection range from 5 × 102 to 5 × 107 copies/104 cells. All data collected were based on the official report by the laboratory test centre of this hospital.

Human papillomavirus infection status

Patients infected by two or more HPV genotypes were defined as having coinfection. An HPV-DNA level > 5 × 106 copies/104 cells was determined to be high-level. Pre-operatively, all patients were classified into negative, low-level or high-level groups. According to the postoperative clearance time, patients were classified into five groups: pre- and postoperative negative, cleared within 12 months, cleared within 12–24 months, cleared after 24 months and uncleared. Based on the time of high HPV-DNA persistence, patients were classified into the groups of postoperative persistence within 12 months, 12–24 months and longer than 24 months.


Using SPSS 26.0 software, the measurement data are described by mean ± standard deviation. The comparison between groups was described with a one-way analysis of variance. The counting data were expressed in the number of cases (percentage) [n (%)]. Either the chi-square or Fisher's exact test was used for comparison between groups. Spearman rank correlation was used in the correlation analysis. The factors affecting postoperative recurrence were explored by univariate analysis, and the meaningful factors were then included in multivariate Cox regression analysis to further explore the independent risk factors affecting postoperative recurrence. The inspection level α = 0.05, p < 0.05 was statistically significant.


Characteristics of patients

The data of 1,030 patients from January 2014 to December 2016 were reviewed, of which 312 met the inclusion criteria. All 312 patients were treated by RH with lymphadenectomy, while 123 patients (39.4%) with pathological risk factors also received postoperative adjuvant radio/chemotherapy. The average age of the 312 patients was 47 (with a range of 25–73) years old. Pathologists confirmed no patients had parametrial invasions or positive resection margins. The average follow-up time was 59.2 months (with a range of 14–77.9 months). The characteristics of the patients are shown in Table 1.

Table 1 Characteristics of patients (n = 312)

Clinical analysis of patients

Among the 312 patients, 266 patients (85.3%) were HPV-positive before the operation, including 227 patients (72.8%) infected by HPV-16/18 and 39 (12.5%) patients infected by 13 other genotypes of HR-HPV. There were 192 patients in the low HPV-DNA level group and 74 patients in the high HPV-DNA level group (Table 2).

Table 2 Clinical data of 312 patients before and after operation

All patients underwent a postoperative HPV test every 3–12 months. Among the 266 pre-operative HPV-positive patients, 209 were HPV-negative within 12 months, during 12–24 months and 4 after 24 months; 32 patients had persistent HPV infection at the end of the 24 months. Additionally, 270 (86.5%) patients were cleared of HPV 24 months post-operation. Regarding the postoperative level of HPV-DNA, 59 patients had a low level of HPV-DNA, and 29 patients had a persistently high level, including 11 patients within 12 months, 8 patients within 12–24 months and 10 patients longer than 24 months (Table 2).

Clinical information and HPV infection in seven recurrent patients

The median follow-up time was 59.2 months (with a range of 14–77.9 months). Seven patients had a local recurrence and five patients had distant metastasis. The average local recurrence time was 12 months (with a range of 6–18 months). Three patients died of an uncontrolled local recurrence, while one died of liver metastasis. The five-year local recurrence-free survival rate was 97.8% (305/312 patients), and the five-year overall survival rate was 98.7% (308/312). The recurrence status of seven patients is demonstrated in Table 3.

Table 3 Clinical information and HPV infection status of 7 recurrent patients

Analysis of influencing factors of recurrence

On univariate analysis, lymph nodes metastasis (hazard ratio [HR] 6.459, 95% confidence interval [CI] 1.445–28.859, p = 0.014*) and postoperative persistent high levels of HPV-DNA within 12 months ((HR 55.5, 95% CI 8.831–348.792, p < 0.01) and 12–24 months (HR 13.875, 95% CI 1.137–169.359, p = 0.039*) were associated with a higher local recurrence. Pre-operative HPV-DNA levels and HPV-16/18 infections had no impact on the local recurrence rate. Multivariate Cox regression analysis showed that the deep 1/3 stromal invasion (HR 114.79, 95% CI 2.821–4670.111, p = 0.012*), postoperative persistent high levels of HPV-DNA within 12 months (HR 269.044, 95% CI 14.437–5013.754, p < 0.001*) and 12–24 months (HR 31.299, 95% CI 1.191–822.215, p = 0.039*) were the independent risk factors for local recurrence (Table 4, Fig. 1).

Table 4 Univariate analysis and multivariate analysis to evaluate the influencing factors of local recurrence
Fig. 1
figure 1

Risk of Local recurrence according to the postoperative HPV-DNA level


According to the 2020 comprehensive global cancer statistics published by the International Agency for Research on Cancer, gynaecological malignancies accounted for 16.5% of an estimated 8.2 million overall new cancer cases in women. Gynaecological cancers represent an ongoing source of concern due to their high incidence and cancer-related mortality [15].

Early-stage patients had a better prognosis than advanced-stage patients (IIB-IV) [16,17,18], but they could have a recurrent disease occasionally. The prognosis of early-stage cervical cancer was related to pathological risk factors, including lymph node metastasis, positive resection margin, tumour size, parametrial invasion, deep stromal invasion and LVSI [19]. The present study showed that deep 1/3 stromal invasion was an independent risk factor of local recurrence (HR 114.79, 95% CI 2.821–4670.111, p = 0.012), which was in accordance with the former study. In addition to pathological risk factors, some studies focused on other factors, such as HPV infection status, including genotypes and viral load.

At present, more than 200 genotypes of HPV have been isolated and the carcinogenicity of different HPV genotypes varies widely [20, 21]. In the present study, the HPV test was based on qRT-PCR, which confirmed that 85.3% (266/312) of patients were HPV-positive. Among the pre-operative HPV-positive patients, 85.3% of them were HPV-16/18 positive, concordant with other studies (70–90%) [22,23,24,25,26]. And among the seven patients with a postoperative recurrence, the genotype of HPV infection in four was HPV-16.

Chen et al. reported that women with viral loads ≥ 5.22 copies/104 cells might have a higher risk for residual lesions (p = 0.007). Furthermore, except for HPV-31/33, the viral loads of HP-16/52/58 showed significant differences in the number of residual lesions (p = 0.016, p < 0.001, p < 0.001). Thus, they concluded that HR-HPV viral loads could be a reliable predictor of residual lesions [27]. The present study showed that the pre-operative HPV viral load was not associated with the local recurrence rate (p > 0.05). Similar findings have been reported by previous studies [28, 29]. However, the present study showed that the postoperative persistence of high HPV-DNA levels within 12 months (HR 269.044, 95% CI 14.437–5013.754, p < 0.001*) and 12–24 months (HR 31.299, 95% CI 1.191–822.215, p = 0.039*) were independent risk factors for a higher local recurrence. Although this conclusion is inconsistent with Mahantshetty et al. [30], both studies used PCR-based HPV tests. Research reports show that using the Digene Hybrid Capture 2 (HC2) HPV DNA test and fluorescence in situ hybridisation (FISH) with a chromosome probe to TERC (3q26) to detect and evaluate HPV also have high sensitivity and specificity [31]. The HPV qRT-PCR kit (Z-ME-0100-50, Liferiver, Shanghai, China) was approved for clinical use by the China Food and Drug Administration. Therefore, more data on postoperative HPV infection statuses, including genotypes and viral loads, through this test method will be available in the future for analysis.

Cervical intraepithelial neoplasia is the precursor of cervical cancer [32]. Adcock et al. [33] reported that the risk of developing high-grade CIN depended on both genotypes and viral loads of HPV. There is an association between diagnosis of CIN3, presence of HR-HPV types, positive endocervical margins, HPV persistence, and the omission of HPV vaccination after conisation and the risk of developing cervical dysplasia persistence/recurrence [34]. Therefore, accurate measurement of the HPV genotype and viral load is essential for the effective diagnosis of cervical cancer and postoperative recurrences of cervical cancer.

This study has some highlights. On the one hand, the genotypes and viral loads of 15 HR-HPV types were evaluated using a highly sensitive and specific HPVqRT-PCR kit. However, this study is the first to examine the relationship between postoperative HPV infection and recurrence. In addition, this study is a statistical analysis based on clinical data, which has high clinical significance. Nevertheless, there are also some limitations to this study. First, it was retrospective and lacked prospective interventional studies to verify. Second, statistics on postoperative complications were lacking, which is also a potential factor that has a great impact on the outcome. Thus, future prospective studies will be conducted to evaluate the prognostic value of postoperative HPV viral loads in IB1-IIA2 cervical cancer patients.


This study shows that a continuously high HPV-DNA level within 24 months after the operation and deep 1/3 interstitial infiltration are independent risk factors for a local recurrence of cervical cancer. Therefore, early and accurate postoperative HPV-DNA detection is useful in evaluating the risk of postoperative recurrence for patients.

Availability of data and materials

All data generated or analyzed during this study are included in this article.


  1. Wei M, Zhou W, Bi Y, Wang H, Liu Y, Zhang ZJ. Rising mortality rate of cervical cancer in younger women in urban China. J Gen Intern Med. 2019;34(2):281–4.

    Article  PubMed  Google Scholar 

  2. Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):e191-203.

    Article  PubMed  Google Scholar 

  3. Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, et al. Cervical cancer, version 3.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2019;17(1):64–84.

    Article  CAS  PubMed  Google Scholar 

  4. Zhang J, Lu Q, Shi NM, Li L, Liu GG, Zhang Z, et al. Investigation on asymptomatic infection and influencing factors of high-risk human papillomavirus in women. China Vaccine Immun. 2019;25(03):296–8.

    Google Scholar 

  5. Bogani G, Sopracordevole F, Di Donato V, Ciavattini A, Ghelardi A, Lopez S, et al. High-risk HPV-positive and -negative high-grade cervical dysplasia: analysis of 5-year outcomes. Gynecol Oncol. 2021;161(1):173–8.

    Article  PubMed  Google Scholar 

  6. Malagón T, Volesky KD, Bouten S, Laprise C, El-Zein M, Franco EL. Cumulative risk of cervical intraepithelial neoplasia for women with normal cytology but positive for human papillomavirus: systematic review and meta-analysis. Int J Cancer. 2020;147(10):2695–707. (Epub 2020 May 26).

    Article  CAS  PubMed  Google Scholar 

  7. Zhang HQ, Chen Q. Distribution characteristics of cervical precancerous lesions and high-risk HPV of cervical cancer. Med Clin Res. 2019;36(9):1841–3.

    Google Scholar 

  8. D’Oria O, Corrado G, Laganà AS, Chiantera V, Vizza E, Giannini A. New advances in cervical cancer: from bench to bedside. Int J Environ Res Public Health. 2022;19(12):7094.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Polman NJ, Snijders PJF, Kenter GG, Berkhof J, Meijer CJLM. HPV-based cervical screening: rationale, expectations and future perspectives of the new Dutch screening programme. Prev Med. 2019;119:108–17. (Epub 2018 Dec 27).

    Article  CAS  PubMed  Google Scholar 

  10. Guo Y, Lin LH, Gao YR. Study on the correlation between high-risk HPV infection and cervical cancer and precancerous lesions. Chin J Cancer Prev Treat. 2018;25(03):156–8.

    Article  CAS  Google Scholar 

  11. Liu Y, Zheng XH, Wang W, Luo SF, Wang LY. Correlation between postoperative recurrence and high-risk human papillomavirus load and continuous positive in patients with cervical cancer and cervical intraepithelial neoplasia. Anhui Med. 2018;22(11):2102–5.

    Article  Google Scholar 

  12. Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. Cancer of the cervix uteri. Int J Gynaecol Obstet. 2018;143(Suppl 2):22–36.

    Article  PubMed  Google Scholar 

  13. Bogani G, Donato VD, Scambia G, Landoni F, Ghezzi F, Muzii L, et al. Practice patterns and 90-day treatment-related morbidity in early-stage cervical cancer. Gynecol Oncol. 2022;166(3):561–6.

    Article  PubMed  Google Scholar 

  14. Bogani G, Di Donato V, Scambia G, Raspagliesi F, Chiantera V, Sozzi G, et al. Radical hysterectomy for early stage cervical cancer. Int J Environ Res Public Health. 2022;19(18):11641.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Giannini A, Bogani G, Vizza E, Chiantera V, Laganà AS, Muzii L, et al. Advances on prevention and screening of gynecologic tumors: Are we stepping forward? Healthcare (Basel). 2022;10(9):1605.

    Article  PubMed  Google Scholar 

  16. Rotman M, Sedlis A, Piedmonte MR, Bundy B, Lentz SS, Muderspach LI, et al. A phase III randomized trial of postoperative pelvic irradiation in Stage IB cervical carcinoma with poor prognostic features: follow-up of a gynecologic oncology group study. Int J Radiat Oncol Biol Phys. 2006;65(1):169–76.

    Article  PubMed  Google Scholar 

  17. Matoda M, Takeshima N, Michimae H, Iwata T, Yokota H, Torii Y, et al. Postoperative chemotherapy for node-positive cervical cancer: results of a multicenter phase II trial (JGOG1067). Gynecol Oncol. 2018;149(3):513–9.

    Article  CAS  PubMed  Google Scholar 

  18. Huang BX, Fang F. Progress in the study of lymph node metastasis in early-stage cervical cancer. Curr Med Sci. 2018;38(4):567–74.

    Article  PubMed  Google Scholar 

  19. Nanthamongkolkul K, Hanprasertpong J. Predictive factors of pelvic lymph node metastasis in early-stage cervical cancer. Oncol Res Treat. 2018;41(4):194–8.

    Article  PubMed  Google Scholar 

  20. Cuzick J, Ho L, Terry G, Kleeman M, Giddings M, Austin J, et al. Individual detection of 14 high risk human papilloma virus genotypes by the PapType test for the prediction of high grade cervical lesions. J Clin Virol. 2014;60(1):44–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Schiffman M, Boyle S, Raine-Bennett T, Katki HA, Gage JC, Wentzensen N, et al. The role of human papillomavirus genotyping in cervical cancer screening: a large-scale evaluation of the cobas HPV test. Cancer Epidemiol Biomarkers Prev. 2015;24(9):1304–10.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kahla S, Kochbati L, Sarraj S, Ben Daya I, Maalej M, Oueslati R. Molecular detection of human papillomavirus and viral DNA load after radiotherapy for cervical carcinomas. Tumori. 2016;102(5):521–6.

    Article  CAS  PubMed  Google Scholar 

  23. Rahimi S. HPV-related squamous cell carcinoma of oropharynx: a review. J Clin Pathol. 2020;73(10):624–9.

    Article  CAS  PubMed  Google Scholar 

  24. Arsa L, Siripoon T, Trachu N, Foyhirun S, Pangpunyakulchai D, Sanpapant S, et al. Discrepancy in p16 expression in patients with HPV-associated head and neck squamous cell carcinoma in Thailand: clinical characteristics and survival outcomes. BMC Cancer. 2021;21(1):504.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Paver EC, Currie AM, Gupta R, Dahlstrom JE. Human papilloma virus related squamous cell carcinomas of the head and neck: diagnosis, clinical implications and detection of HPV. Pathology. 2020;52(2):179–91. (Epub 2019 Dec 27).

    Article  PubMed  Google Scholar 

  26. Wang F, Zhang H, Xue Y, Wen J, Zhou J, Yang X, et al. A systematic investigation of the association between HPV and the clinicopathological parameters and prognosis of oral and oropharyngeal squamous cell carcinomas. Cancer Med. 2017;6(5):910–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Chen L, Dong B, Zhang Q, Mao X, Lin W, Ruan G, et al. HR-HPV viral load quality detection provide more accurate prediction for residual lesions after treatment: a prospective cohort study in patients with high-grade squamous lesions or worse. Med Oncol. 2020;37(5):37.

    Article  CAS  PubMed  Google Scholar 

  28. Chen X, Zhang P, Chen S, Zhu H, Wang K, Ye L, et al. Better or worse? The independent prognostic role of HPV-16 or HPV-18 positivity in patients with cervical cancer: a meta-analysis and systematic review. Front Oncol. 2020;7(10):1733.

    Article  Google Scholar 

  29. Kim YM, Park JY, Lee KM, Kong TW, Yoo SC, Kim WY, et al. Does pretreatment HPV viral load correlate with prognosis in patients with early stage cervical carcinoma? J Gynecol Oncol. 2008;19(2):113–6. (Epub 2008 Jun 20).

    Article  PubMed  PubMed Central  Google Scholar 

  30. Mahantshetty U, Teni T, Naga P, Hotwani C, Umesh S, Kannan S, et al. Impact of HPV 16/18 infection on clinical outcomes in locally advanced cervical cancers treated with radical radio (chemo) therapy - a prospective observational study. Gynecol Oncol. 2018;148(2):299–304.

    Article  PubMed  Google Scholar 

  31. Chen SM, Lin W, Liu X, Zhang YZ. Significance of human telomerase RNA gene amplification detection for cervical cancer screening. Asian Pac J Cancer Prev. 2012;13(5):2063–8.

    Article  PubMed  Google Scholar 

  32. Njagi SK, Ngure K, Mwaniki L, Kiptoo M, Mugo NR. Prevalence and correlates of cervical squamous intraepithelial lesions among HIV-infected and uninfected women in Central Kenya. Pan Afr Med J. 2021;18(39):44.

    Article  Google Scholar 

  33. Adcock R, Cuzick J, Hunt WC, McDonald RM, Wheeler CM, New Mexico HPV Pap Registry Steering Committee. Role of HPV genotype, multiple infections, and viral load on the risk of high-grade cervical neoplasia. Cancer Epidemiol Biomarkers Prev. 2019;28(11):1816-1824.

  34. Bogani G, Lalli L, Sopracordevole F, Ciavattini A, Ghelardi A, Simoncini T, et al. Development of a nomogram predicting the risk of persistence/recurrence of cervical dysplasia. Vaccines (Basel). 2022;10(4):579.

    Article  PubMed  Google Scholar 

Download references


Not applicable.


Not applicable.

Author information

Authors and Affiliations



Conception and design: JZ and LW. Administrative support: JZ, NL, HY and YZ. Provision of study materials or patients: YZ, TW and LX. Data analysis and interpretation: JL, JY and LL. Manuscript writing: All authors. Final approval of manuscript: All authors.

Corresponding author

Correspondence to LingYing Wu.

Ethics declarations

Ethics approval and consent to participate

This study was conducted in accordance with the declaration of Helsinki.This study was conducted with approval from the Ethics Committee of Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College. Written informed consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

All of the authors had no any personal, financial, commercial, or academic conflicts of interest separately.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zeng, J., Zuo, J., Li, N. et al. Clinical analysis of 312 patients with stage IB1-IIA2 cervical squamous cell carcinoma and research on the influencing factors of postoperative recurrence. BMC Women's Health 23, 82 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI:


  • Cervical cancer
  • Radical hysterectomy
  • Human papillomavirus
  • Viral load
  • Recurrence