HPV status as a predictor of ovarian metastasis in cervical adenocarcinoma: implications for surgical decision-making

Human papillomavirus (HPV) infection does not drive all cervical adenocarcinomas. HPV-independent cervical adenocarcinomas exhibit distinct histologic subtypes, metastatic patterns, and prognoses. This study aimed to compare the incidence of ovarian metastasis between HPV-related and HPV-independent cervical adenocarcinomas.​​ We conducted a retrospective analysis of cervical adenocarcinoma patients treated at Beijing Obstetrics and Gynecology Hospital, Capital Medical University, from 2012 to 2022. Ovarian metastasis rates were compared between HPV-related and HPV-independent cohorts.​ Among 444 cervical adenocarcinoma patients, 10.58% (47/444) had HPV-independent tumors. The ovarian metastasis rate was significantly higher in HPV-independent versus HPV-related cases (36.17% vs. 2.02%, p < 0.001). Among patients with pathologically confirmed metastasis, the rates of macroscopic suspected metastasis were comparable between two groups (HPV-independent: 62.5% vs. HPV-related: 58.8%, p = 0.861). Oophorectomy was more frequently performed in HPV-independent patients (93.60% vs. 75.06%, p = 0.004). No ovarian metastases were detected during follow-up in patients who underwent ovarian preservation. Multivariate analysis confirmed HPV-independent status as an independent risk factor for ovarian involvement (HR = 19.66, 95% CI: 5.23–73.91, p < 0.01).​. HPV-independent status is a strong independent predictor of ovarian metastasis in cervical adenocarcinoma. These findings support ovarian preservation in HPV-related tumors without intraoperative evidence of suspected metastasis.​.