Depok, 5 January 2026 — The Doctoral Program in Epidemiology, Faculty of Public Health (FPH), Universitas Indonesia (UI), conducted an Open Doctoral Promotion Examination in Epidemiology for Widyorini Lestari Hardjolukito Hanafy on Monday, 5 January 2025, at the Doctoral Promotion Hall of FPH UI. The examination was chaired by Prof. Dr. Indri Hapsari Susilowati, S.K.M., M.K.K.K., with Prof. dr. Asri C. Adisasmita, M.P.H., M.Phil., Ph.D. serving as Supervisor, and Dr. dr. Bambang Dwipoyono, Sp.OG., M.S., M.A.R.S. and Dr. Sukwan Handali, Ph.D. as Co-Supervisors. Prof. Dr. dr. Ratna Juwita, M.P.H. acted as Chair of the Board of Examiners, with the examination committee consisting of Prof. dr. Mondastri Korib Sudaryo, M.S., D.Sc.; Prof. Dr. dr. Syahrul Rauf, Sp.OG., Subsp. Onk.; Dr. dr. Primariadewi Rustamadji, M.M., Sp.PA(K); and Dr. dr. M. Soemanadi, Sp.OG. During the examination, Widyorini successfully defended her dissertation entitled “Human Papillomavirus (HPV) DNA Genotypes (Single/Multiple Infections) and HPV Viral Load as Prognostic Factors for Recurrence in Stage IA2–IIA2 Cervical Cancer Based on FIGO 2009.”
This dissertation addresses the persistent burden of cervical cancer, which remains a major health problem among women globally and in Indonesia. In the early stages—specifically stages IA2–IIA2 according to FIGO 2009—the standard treatment is radical hysterectomy with or without adjuvant therapy. However, recurrence rates at these stages remain relatively high, even when established prognostic factors such as tumor size, surgical margins, lymph node involvement, and depth of stromal invasion are controlled. This condition suggests the involvement of other prognostic factors, particularly virological factors related to HPV infection.
Widyorini explained that high-risk HPV infection is the primary cause of cervical cancer; however, the roles of HPV DNA genotypes—both single and multiple infections—and HPV viral load as prognostic factors for recurrence in stage IA2–IIA2 cervical cancer have not been widely studied, especially in Indonesia. Therefore, this study aimed to assess the prognostic value of HPV DNA genotypes and HPV viral load in predicting recurrence of stage IA2–IIA2 cervical cancer based on FIGO 2009.
This study was an analytic observational study using a retrospective cohort design. Data were retrospectively collected from patients with stage IA2–IIA2 cervical cancer who underwent radical hysterectomy at Dharmais Cancer Hospital and were followed for up to five years. Cervical cancer recurrence was operationally defined as local, locoregional, or distant metastatic recurrence occurring after primary therapy, as assessed through clinical data and medical records during the follow-up period. The primary outcome of the study was Disease-Free Survival (DFS), defined as the time from treatment to the first recurrence or the end of the observation period. HPV genotyping was performed to identify high-risk HPV types in both single and multiple infections, while HPV viral load was measured and categorized as high or low.
The study highlighted the use of molecular approaches to examine HPV DNA genotypes and viral load from primary tumor tissue and lymph node specimens. Genotyping was conducted to identify high-risk HPV types and to distinguish between single and multiple infections, while HPV viral load assessment quantified the amount of viral DNA present in tumor tissue. This approach represents one of the early studies in Indonesia integrating HPV genotype and viral load analyses as prognostic factors for recurrence in early to early-advanced cervical cancer, offering new perspectives on post-treatment risk assessment.
The results demonstrated that HPV DNA genotype and HPV viral load are significant prognostic factors for recurrence in stage IA2–IIA2 cervical cancer. Multiple HPV infections were identified as the strongest independent prognostic factor associated with a higher risk of recurrence compared to single infections. In addition, higher HPV viral load was associated with an increased risk of recurrence. These findings underscore the important role of virological factors in determining the clinical course of cervical cancer, beyond conventional clinicopathological factors.
Based on these findings, Widyorini emphasized that this study makes a meaningful contribution to scientific development, particularly in the fields of clinical epidemiology, gynecologic oncology, and molecular biology. The research enriches the existing evidence on the prognostic value of HPV genotype and viral load in stage IA2–IIA2 cervical cancer, which has previously been more extensively studied in advanced stages. From a public health and health services perspective, these findings have the potential to support recurrence risk stratification, enabling high-risk patients to receive closer monitoring and more targeted follow-up care, thereby contributing to improved quality of care and clinical outcomes.
As a recommendation, Widyorini suggested that HPV DNA genotyping and HPV viral load assessment be considered as part of prognostic evaluation in early-stage cervical cancer, particularly in cases of multiple HPV infections. Immunohistochemical examinations of p16 and p53 are also important to enhance the validity of molecular HPV data that may not be detected by certain diagnostic tools. Furthermore, future multicenter studies involving Type B and C hospitals are recommended to obtain larger sample sizes to strengthen these findings and to support the development of national guidelines for the management of early-stage cervical cancer.
Based on the successful defense of her dissertation, Widyorini Lestari Hardjolukito Hanafy was awarded the degree of Doctor of Epidemiology with a very satisfactory distinction. She is the first doctoral graduate of the Epidemiology Program in 2026, the 126th doctoral graduate of the Epidemiology Doctoral Program, and the 489th doctoral graduate of FPH UI overall. (promovendus)