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Bersani C, Mints M, Tertipis N, Haeggblom L, Sivars L, Ährlund-Richter A, Vlastos A, Smedberg C, Grün N, Munck-Wikland E, Näsman A, Ramqvist T, Dalianis T. A model using concomitant markers for predicting outcome in human papillomavirus positive oropharyngeal cancer. Oral Oncol 2017; 68:53-59. [PMID: 28438294 DOI: 10.1016/j.oraloncology.2017.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/21/2017] [Accepted: 03/13/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Head-neck cancer therapy has become intensified. With radiotherapy alone, 3-year disease-free survival (DFS) is 80% for HPV-positive TSCC/BOTSCC and better for patients with favorable characteristics, suggesting therapy could be tapered for some, decreasing side-effects. Therefore, we built a model to predict progression-free survival for patients with HPV-positive TSCC and BOTSCC. MATERIAL AND METHODS TSCC/BOTSCC patients treated curatively between 2000 and 2011, with HPV16 DNA/E7 mRNA positive tumors examined for CD8+ TILs, HPV16 mRNA and HLA class I expression were included. Patients were split randomly 65/35 into training and validation sets, and LASSO regression was used to select a model in the training set, the performance of which was evaluated in the validation set. RESULTS 258 patients with HPV DNA/E7 mRNA positive tumors could be included, 168 and 90 patients in the respective sets. No treatment improved prognosis compared to radiotherapy alone. CD8+ TIL counts and young age were the strongest predictors of survival, followed by T-stage <3 and presence of HPV16 E2 mRNA. The model had an area under curve (AUC) of 76%. A model where the presence of three of four of these markers defined good prognosis captured 56% of non-relapsing patients with a positive predictive value of 98% in the validation set. Furthermore, the model identified 35% of our cohort that was overtreated and could safely have received de-escalated therapy. CONCLUSION CD8+ TIL counts, age, T-stage and E2 expression could predict progression-free survival, identifying patients eligible for randomized trials with milder treatment, potentially reducing side effects without worsening prognosis.
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Affiliation(s)
- Cinzia Bersani
- Dept. of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden.
| | - Michael Mints
- Dept. of Medicine, Karolinska Institutet, 171 76 Stockholm, Sweden; Dept. of Surgical and Perioperative Sciences, Umeå University, 901 87 Umeå, Sweden
| | - Nikolaos Tertipis
- Dept. of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Linnea Haeggblom
- Dept. of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Lars Sivars
- Dept. of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden
| | | | - Andrea Vlastos
- Dept. of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden; Dept. of Clinical Science and Technology, Karolinska Institutet, 171 76 Stockholm, Sweden; Dept. of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Cecilia Smedberg
- Dept. of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Nathalie Grün
- Dept. of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Eva Munck-Wikland
- Dept. of Clinical Science and Technology, Karolinska Institutet, 171 76 Stockholm, Sweden; Dept. of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Anders Näsman
- Dept. of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Torbjörn Ramqvist
- Dept. of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Tina Dalianis
- Dept. of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden.
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Haeggblom L, Nordfors C, Tertipis N, Bersani C, Ramqvist T, Näsman A, Dalianis T. Effects of irradiation on human leukocyte antigen class I expression in human papillomavirus positive and negative base of tongue and mobile tongue squamous cell carcinoma cell lines. Int J Oncol 2017; 50:1423-1430. [PMID: 28350079 DOI: 10.3892/ijo.2017.3916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/06/2017] [Indexed: 11/05/2022] Open
Abstract
Human papillomavirus (HPV) infection is a risk factor for oropharyngeal cancer, besides smoking and alcohol. Patients with HPV-positive tumors have a better prognosis than those with HPV-negative tumors. Furthermore, patients with HPV-positive tumors, with high CD8+ tumor infiltrating lymphocyte counts or absent/low human leukocyte antigen (HLA) class I expression have the best outcome. The latter is paradoxical, since HLA class I expression is important for tumor recognition. Below, the hypothesis that radiation therapy increases HLA class I expression was tested. HPV16 positive head and neck cancer cell lines UPCI-SCC-154, UPCI-SCC-090 and UM-SCC-47, and the HPV-negative cancer cell line UT-SCC-14, were treated with 2-10 Gray (Gy) and tested for HLA class I expression, cell cycle changes and apoptosis by flow cytometry. HPV16 E5, E7 and HLA-A mRNA expression was tested by quantitative PCR. A dose of 10 Gy resulted in a tendency of increased HLA class I cell surface expression for all cell lines and reached statistical significance for UPCI-SCC-154 and UPCI-SCC-090. There were, however, no significant changes in HLA-A mRNA expression in any of the cell lines, or HPV16 E5, or E7 mRNA expression for UPCI-SCC-47 and UPCI-SCC-154, while for UPCI-SCC-090 HPV16 E5 mRNA decreased. In all cell lines there was a shift towards G2/M phase and increased apoptosis after irradiation with 10 Gy. To conclude, irradiation with 10 Gy increased HLA class I expression in the HPV-positive cell lines UPCI-SCC-154 and UPCI-SCC-090. A similar tendency was observed for HPV-positive UM-SCC-47 and HPV-negative UT-SCC-14.
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Affiliation(s)
- Linnea Haeggblom
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska (CCK), Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Cecilia Nordfors
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Nikolaos Tertipis
- Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Cinzia Bersani
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska (CCK), Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska (CCK), Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Anders Näsman
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska (CCK), Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska (CCK), Karolinska University Hospital, 171 76 Stockholm, Sweden
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53
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Grün N, Mbuya W, Ternhag A, Ramqvist T, Ahlberg A, Jangard M, Dalianis T, Hammarstedt-Nordenvall L. Human papillomavirus prevalence in mouthwashes of patients undergoing tonsillectomy shows dominance of HPV69, without the corresponding finding in the tonsils. Infect Dis (Lond) 2017; 49:588-593. [PMID: 28293975 DOI: 10.1080/23744235.2017.1300319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The role of human papillomavirus (HPV) in tonsillar squamous cell carcinomas (TSCC) is of interest, since a considerable proportion of TSCC in Sweden and other Western countries is HPV positive. Nevertheless, the natural history of HPV in normal tonsils, and the progression from localized infection to pre-malignant lesion to cancer are poorly understood. The aim of this study was to investigate whether HPV types found in mouthwash samples correlated to those in tonsillar tissue from the same individuals undergoing tonsillectomy. METHODS Mouthwash samples from 232 patients, aged 3-56 years, undergoing tonsillectomy, the majority with chronic tonsillitis, were collected at the time of surgery and analysed for the presence of 27 HPV types by a bead based multiplex assay. RESULTS An HPV prevalence of 10.3% (24/232) was observed in mouthwash samples, with HPV 69 being the dominant type (10/24). Ten patients were positive for high risk HPV (HPV 16, 33, 35, 45, 56, 59). None of the tonsils resected from patients with HPV-positive mouthwash samples were positive for HPV. CONCLUSIONS Despite an oral HPV prevalence of 10.3% in mouthwash samples from tonsillectomized patients, with dominance of HPV 69, none of the corresponding tonsillar samples exhibited the presence of HPV.
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Affiliation(s)
- Nathalie Grün
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden
| | - Wilbert Mbuya
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden
| | - Anders Ternhag
- b Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden
| | - Torbjörn Ramqvist
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden
| | - Alexander Ahlberg
- c Capio ENT Globen and CFTK , Capio Specialist Clinics , Stockholm , Sweden
| | - Mattias Jangard
- d ENT Unit, Research Laboratory , Sophiahemmet University , Stockholm , Sweden
| | - Tina Dalianis
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden
| | - Lalle Hammarstedt-Nordenvall
- e Department of Clinical Sciences and Technology , Karolinska Institutet , Stockholm , Sweden.,f Department of ENT , Karolinska University Hospital , Stockholm , Sweden
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54
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Sivars L, Landin D, Grün N, Vlastos A, Marklund L, Nordemar S, Ramqvist T, Munck-Wikland E, Näsman A, Dalianis T. Validation of Human Papillomavirus as a Favourable Prognostic Marker and Analysis of CD8 + Tumour-infiltrating Lymphocytes and Other Biomarkers in Cancer of Unknown Primary in the Head and Neck Region. Anticancer Res 2017; 37:665-673. [PMID: 28179315 DOI: 10.21873/anticanres.11362] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) is a favourable prognostic factor in oropharyngeal cancer. Moreover, we and others reported that HPV-positive cancer of unknown primary in the head and neck region (HNCUP) has better outcome than HPV-negative HNCUP. However, not all studies concord. Here, our previous finding was investigated in a new cohort and additional biomarkers were analyzed. MATERIALS AND METHODS A total of 19 HNCUPs diagnosed 2008-2013 were analyzed for HPV DNA by polymerase chain reaction assay (PCR) and p16 by immunohistochemistry (IHC). Thereafter, 69 HNCUPs diagnosed between 2000-2013 were analyzed for HPV16 mRNA by PCR (if HPV16DNA-positive) and cluster of differentiation 8 positive (CD8+) tumour-infiltrating lymphocytes (TILs) and human leukocyte antigen (HLA) class I-expression using IHC. RESULTS HPV DNA, alone and in combination with p16 overexpression, was validated as a favourable prognostic factor in HNCUP. HPV16 mRNA was present in most HPV16 DNA-positive cases, confirming HPV-driven carcinogenesis in HNCUP. High CD8+ TIL counts indicated favourable prognosis. CONCLUSION HPV status is useful for the management of patients with HNCUP and the role of CD8+ TILs should be further explored.
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Affiliation(s)
- Lars Sivars
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - David Landin
- Department of Clinical Science, Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
| | - Nathalie Grün
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Andrea Vlastos
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
| | - Linda Marklund
- Department of Clinical Science, Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
| | - Sushma Nordemar
- Department of Clinical Science, Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
| | - Torbjörn Ramqvist
- Department of Clinical Science, Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
| | - Eva Munck-Wikland
- Department of Clinical Science, Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
| | - Anders Näsman
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Tina Dalianis
- Department of Clinical Science, Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
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55
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Franzén J, Ramqvist T, Bogdanovic G, Grün N, Mattson J, Dalianis T. Studies of human polyomaviruses, with HPyV7, BKPyV, and JCPyV present in urine of allogeneic hematopoietic stem cell transplanted patients with or without hemorrhagic cystitis. Transpl Infect Dis 2017; 18:240-6. [PMID: 26809742 DOI: 10.1111/tid.12500] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/06/2015] [Accepted: 11/06/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND BK polyomavirus (BKPyV) can cause hemorrhagic cystitis (HC) in allogeneic hematopoietic stem cell transplant (allo-HSCT) patients and polyomavirus-associated nephritis in renal transplant patients, while JC polyomavirus (JCPyV) can generate progressive multifocal leukoencephalopathy in immunocompromised individuals. Since 2007, additional human polyomaviruses (HPyVs) have been identified. In this study, we examined the urines of allo-HSCT patients for possible presence of polyomaviruses BKPyV, JCPyV, KIPyV, WUPyV, MCPyV, HPyV6, HPyV7, TSPyV, HPyV9, and HPyV10 (MWPyV). METHODS A total of 185 urinary samples obtained 2002-2007 from 105 allo-HSCT patients, 32/105 with HC, were tested for the above-listed HPyVs by a bead-based multiplex assay. Of these, 142 urine samples had previously been tested for BKPyV and JCPyV by nested polymerase chain reaction (PCR). RESULTS Aside from BKPyV and JCPyV, which dominated, HPyV7 was detected in 5 BKPyV-positive urinary samples from 1 patient. The multiplex assay was more sensitive and specific than the nested PCR. BKPyV and/or JCPyV were found in all but 1 of the previously BKPyV- or JCPyV-positive samples, although 6 previously BKPyV-positive cases were now JCPyV-positive or the reverse. Furthermore, 18/79 previously negative samples were found to be BKPyV and/or JCPyV positive, and a total of 21 double infections were found. Lastly, in 1/29 HC patients, only JCPyV was detected. CONCLUSION HPyV7 was found for the first time in urine of an allo-HSCT patient, and BKPyV and JCPyV were more commonly found in urine samples using the bead-based assay compared to testing by nested PCR. Finally, only JCPyV was detected in the urine of 1 HC patient.
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Affiliation(s)
- J Franzén
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - T Ramqvist
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - G Bogdanovic
- Department of Molecular Microbiology, Tumour Biology and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - N Grün
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J Mattson
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - T Dalianis
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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56
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Sivars L, Landin D, Haeggblom L, Tertipis N, Grün N, Bersani C, Marklund L, Ghaderi M, Näsman A, Ramqvist T, Nordfors C, Munck-Wikland E, Tani E, Dalianis T. Human papillomavirus DNA detection in fine-needle aspirates as indicator of human papillomavirus-positive oropharyngeal squamous cell carcinoma: A prospective study. Head Neck 2016; 39:419-426. [PMID: 27898186 DOI: 10.1002/hed.24641] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/01/2016] [Accepted: 10/21/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (SCC) has a better outcome than most head neck squamous cell carcinomas (HNSCCs) and an HPV-positive lymph node metastasis likely has an HPV-positive oropharyngeal SCC origin. Determining HPV-status in cervical lymph nodes by fine-needle aspiration cytology (FNAC) may be useful for diagnosis. METHODS FNACs from 66 patients with neck masses were prospectively examined for HPV DNA and HPV16 mRNA by a polymerase chain reaction (PCR)-based assay, and the data correlated to diagnosis and HPV-status obtained from histopathological specimens. RESULTS Aspirates from 17 of 66 patients, later diagnosed with HPV-positive oropharyngeal SCC, were HPV16 DNA-positive. HPV16 mRNA was detected in all cases with extractable RNA. All remaining FNACs, including 18 branchial cleft cysts, were HPV DNA-negative. HPV DNA status in the aspirates showed perfect concordance with corresponding biopsies. CONCLUSION HPV16 DNA detection in fine-needle aspirations from neck masses is reliable and HPV16 DNA in a metastasis is a strong indicator of an HPV-positive oropharyngeal SCC. © 2016 Wiley Periodicals, Inc. Head Neck 39: 419-426, 2017.
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Affiliation(s)
- Lars Sivars
- Department of Oncology - Pathology, Karolinska Institutet, Stockholm, Sweden
| | - David Landin
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Linnea Haeggblom
- Department of Oncology - Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Nikolaos Tertipis
- Department of Oncology - Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Nathalie Grün
- Department of Oncology - Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Cinzia Bersani
- Department of Oncology - Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Linda Marklund
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Mehran Ghaderi
- Department of Oncology - Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Näsman
- Department of Oncology - Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Torbjörn Ramqvist
- Department of Oncology - Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Nordfors
- Department of Oncology - Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Biochemistry and Microbiology, Microbiology - Immunology, Uppsala University, Uppsala, Sweden
| | - Eva Munck-Wikland
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Edneia Tani
- Department of Oncology - Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Tina Dalianis
- Department of Oncology - Pathology, Karolinska Institutet, Stockholm, Sweden
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57
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Ilmarinen T, Lont T, Hagström J, Tervahartiala T, Sorsa T, Haglund C, Munck-Wickland E, Ramqvist T, Dalianis T, Aaltonen LM. Systemic matrix metalloproteinase-8 response in chronic tonsillitis. Infect Dis (Lond) 2016; 49:302-307. [DOI: 10.1080/23744235.2016.1248484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Taru Ilmarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Triin Lont
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Hagström
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
| | - Taina Tervahartiala
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Timo Sorsa
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
- Department of Dental Medicine, Karolinska Institutet and Karolinska University Hospital, Huddinge and Stockholm, Sweden
| | - Caj Haglund
- Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
- Department of Surgery and Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eva Munck-Wickland
- Department of Clinical Science, Intervention Technology, Division of ENT Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska R8:01, Karolinska University Hospital, Stockholm, Sweden
| | - Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska R8:01, Karolinska University Hospital, Stockholm, Sweden
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Sivars L, Bersani C, Grün N, Ramqvist T, Munck-Wikland E, Von Buchwald C, Dalianis T. Human papillomavirus is a favourable prognostic factor in cancer of unknown primary in the head and neck region and in hypopharyngeal cancer. Mol Clin Oncol 2016; 5:671-674. [PMID: 28105346 DOI: 10.3892/mco.2016.1050] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 09/08/2016] [Indexed: 11/05/2022] Open
Abstract
Human papillomavirus (HPV), in addition to smoking and alcohol, is a cause of oropharyngeal squamous cell carcinoma (OPSCC), particularly of the tonsils and base of the tongue (TSCC and BOTSCC, respectively). Moreover, HPV-positive TSCC and BOTSCC are associated with a better outcome compared with their HPV-negative counterparts (80 vs. 40% 3-year disease-free survival rate, respectively) and their incidence has increased in several countries. Recently, accumulating evidence of HPV in a considerable proportion of cancers of unknown primary (CUP) in the head and neck region and in a small proportion of hypopharyngeal SCCs has been reported. Furthermore, HPV-positive tumours, particularly cases with HPV DNA positivity in combination with overexpression of p16, also tend to have a better clinical outcome compared with that of the corresponding HPV-negative tumours. This finding is particularly prominent in HPV-positive CUPs of the head and neck region, where the primary tumour likely originates from the oropharynx. Thus, the determination of HPV status and p16 expression may be of value for the diagnosis and treatment of CUP of the head and neck region and may also be of value for hypopharyngeal cancers in the future. However, for hypopharyngeal cancer as well as other non-OPSCCs, additional studies per subsite on the effect of HPV status on survival are required.
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Affiliation(s)
- Lars Sivars
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Cinzia Bersani
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Nathalie Grün
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Eva Munck-Wikland
- Department of Clinical, Technical Sciences and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - Christian Von Buchwald
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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Saber CN, Grønhøj Larsen C, Dalianis T, von Buchwald C. Immune cells and prognosis in HPV-associated oropharyngeal squamous cell carcinomas: Review of the literature. Oral Oncol 2016; 58:8-13. [DOI: 10.1016/j.oraloncology.2016.04.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/05/2016] [Accepted: 04/12/2016] [Indexed: 02/07/2023]
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60
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Chaturvedi AK, Song H, Rosenberg PS, Ramqvist T, Anderson WF, Munck-Wikland E, Ye W, Dalianis T. Tonsillectomy and Incidence of Oropharyngeal Cancers. Cancer Epidemiol Biomarkers Prev 2016; 25:944-50. [DOI: 10.1158/1055-9965.epi-15-0907] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/27/2016] [Indexed: 11/16/2022] Open
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61
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Sivars L, Tani E, Näsman A, Ramqvist T, Munck-Wikland E, Dalianis T. Human Papillomavirus as a Diagnostic and Prognostic Tool in Cancer of Unknown Primary in the Head and Neck Region. Anticancer Res 2016; 36:487-493. [PMID: 26851001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Human papillomavirus (HPV) is recognized as a risk factor for oropharyngeal squamous cell carcinomas (SCC), especially tonsillar and base of tongue cancer. Furthermore, HPV-positive tonsillar and base of tongue SCC have a significantly better prognosis than their HPV-negative counterparts and head and neck cancer (HNSCC) in general. HPV has recently also been implicated in cancer of unknown primary (CUP) in the head and neck region, where a primary tumour is not found despite extensive workup. Using fine-needle aspiration cytology to determine CUP HPV status in cervical lymph nodes could be of advantage, since it is minimally invasive and it is assumed that an HPV-positive lymph node metastasis likely has an HPV-positive otopharyngeal SCC origin. We review the current knowledge of HPV in HNSCC, with an emphasis on CUP of the head and neck region, its relation to oropharyngeal, tonsillar and base of tongue SCC and implications of HPV status for diagnosis, prognosis and treatment.
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Affiliation(s)
- Lars Sivars
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Edneia Tani
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Näsman
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Eva Munck-Wikland
- Department of Oto-rhino-laryngology, Head and Neck Surgery Karolinska University Hospital and Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
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Grandahl M, Rosenblad A, Stenhammar C, Tydén T, Westerling R, Larsson M, Oscarsson M, Andrae B, Dalianis T, Nevéus T. School-based intervention for the prevention of HPV among adolescents: a cluster randomised controlled study. BMJ Open 2016; 6:e009875. [PMID: 26817639 PMCID: PMC4735203 DOI: 10.1136/bmjopen-2015-009875] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To improve primary prevention of human papillomavirus (HPV) infection by promoting vaccination and increased condom use among upper secondary school students. DESIGN Cluster randomised controlled trial. SETTING 18 upper secondary schools in Sweden. PARTICIPANTS Schools were first randomised to the intervention or the control group, after which individual classes were randomised so as to be included or not. Of the 832 students aged 16 years invited to participate during the regular individual health interview with the school nurse, 751 (90.2%) agreed to participate and 741 (89.1%) students completed the study. INTERVENTIONS The intervention was based on the Health Belief Model (HBM). According to HBM, a person's health behaviour can be explained by individual beliefs regarding health actions. School nurses delivered 30 min face-to-face structured information about HPV, including cancer risks and HPV prevention, by propagating condom use and HPV vaccination. Students in the intervention and the control groups completed questionnaires at baseline and after 3 months. MAIN OUTCOME MEASURES Intention to use condom with a new partner and beliefs about primary prevention of HPV, and also specifically vaccination status and increased condom use. RESULTS All statistical analyses were performed at the individual level. The intervention had a significant effect on the intention to use condom (p=0.004). There was also a significant effect on HBM total score (p=0.003), with a 2.559 points higher score for the intervention group compared to the controls. The influence on the HBM parameters susceptibility and severity was also significant (p<0.001 for both variables). The intervention also influenced behaviour: girls in the intervention group chose to have themselves vaccinated to a significantly higher degree than the controls (p=0.02). No harms were reported. CONCLUSIONS The school-based intervention had favourable effects on the beliefs about primary prevention of HPV, and increased the HPV vaccination rates in a diverse population of adolescents. TRIAL REGISTRATION NUMBER NCT02280967; Results.
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Affiliation(s)
- Maria Grandahl
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Andreas Rosenblad
- Centre for Clinical Research Västerås, Uppsala University, Västerås, Sweden
| | - Christina Stenhammar
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Tanja Tydén
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ragnar Westerling
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Margareta Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marie Oscarsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Bengt Andrae
- Centre for Research and Development, Uppsala University/Region of Gävleborg, Gävle, Sweden
| | - Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Tryggve Nevéus
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Ramqvist T, Mints M, Tertipis N, Näsman A, Romanitan M, Dalianis T. Studies on human papillomavirus (HPV) 16 E2, E5 and E7 mRNA in HPV-positive tonsillar and base of tongue cancer in relation to clinical outcome and immunological parameters. Oral Oncol 2015; 51:1126-31. [DOI: 10.1016/j.oraloncology.2015.09.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/09/2015] [Accepted: 09/13/2015] [Indexed: 12/31/2022]
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Grün N, Ährlund-Richter A, Franzén J, Mirzaie L, Marions L, Ramqvist T, Dalianis T. Follow-up on oral and cervical human papillomavirus prevalence 2013-2015 in youth at a youth clinic in Stockholm, Sweden. Infect Dis (Lond) 2015; 48:169-70. [PMID: 26536907 DOI: 10.3109/23744235.2015.1094573] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nathalie Grün
- a From the Department of Oncology-Pathology , Södersjukhuset , Stockholm , Sweden
| | | | - Joar Franzén
- a From the Department of Oncology-Pathology , Södersjukhuset , Stockholm , Sweden
| | - Leila Mirzaie
- a From the Department of Oncology-Pathology , Södersjukhuset , Stockholm , Sweden
| | - Lena Marions
- b From the Department of Clinical Science and Education , Södersjukhuset , Stockholm , Sweden
| | - Torbjörn Ramqvist
- a From the Department of Oncology-Pathology , Södersjukhuset , Stockholm , Sweden
| | - Tina Dalianis
- a From the Department of Oncology-Pathology , Södersjukhuset , Stockholm , Sweden
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Tertipis N, Hammar U, Näsman A, Vlastos A, Nordfors C, Grün N, Ährlund-Richter A, Sivars L, Haeggblom L, Marklund L, Hammarstedt-Nordenvall L, Chaturvedi AK, Munck-Wikland E, Ramqvist T, Bottai M, Dalianis T. A model for predicting clinical outcome in patients with human papillomavirus-positive tonsillar and base of tongue cancer. Eur J Cancer 2015; 51:1580-7. [PMID: 26025766 DOI: 10.1016/j.ejca.2015.04.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 04/28/2015] [Accepted: 04/30/2015] [Indexed: 12/31/2022]
Abstract
AIM To combine clinical and molecular markers into an algorithm for predicting outcome for individual patients with human papillomavirus (HPV) DNA/p16(INK4a) positive tonsillar and base of tongue squamous cell carcinoma (TSCC and BOTSCC). BACKGROUND Head-neck cancer treatment has become more intensified, comprising not only surgery and radiotherapy, but also induction/concomitant chemotherapy and targeted therapy. With less treatment, 3-year disease free survival (DFS) is 80% for HPV-positive TSCC and BOTSCC. An 85-100% 3-year DFS is observed for HPV(+) TSCC and BOTSCC with absence of HLA class I, or CD44 expression, or high CD8(+) tumour-infiltrating lymphocyte (TIL) counts suggesting that therapy could be tapered for many if patients could be identified individually. PATIENTS AND METHODS Patients treated curatively, with HPV DNA/p16(INK4a) positive tumours examined for HLA class I and II, CD44 and CD8(+)TILs, were included. An L1-regularised logistic regression was used to evaluate the effect of the biomarker data, age, stage, diagnosis, smoking and treatment on 3-year risk of death or relapse on a training cohort of 197 patients diagnosed 2000-2007 and validated on a cohort of 118 patients diagnosed 2008-2011. RESULTS The variables finally included in the model were HLA class I, CD8(+) TILs, age, stage and diagnosis (TSCC or BOTSCC). The model showed acceptable discrimination and calibration. The discriminative ability of the model did not diminish after validation (AUC=0.77). CONCLUSION To our knowledge, this is the first model to utilise information from several markers to predict an individual probability of clinical outcome for patients with HPV DNA/p16(INK4a) positive tumours.
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Affiliation(s)
- Nikolaos Tertipis
- Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Hammar
- Dept. of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Näsman
- Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Vlastos
- Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Dept. of Clinical Science and Technology, Karolinska Institutet, Stockholm, Sweden; Dept. of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Nordfors
- Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Nathalie Grün
- Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | | | - Lars Sivars
- Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Linnea Haeggblom
- Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Linda Marklund
- Dept. of Clinical Science and Technology, Karolinska Institutet, Stockholm, Sweden; Dept. of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Lalle Hammarstedt-Nordenvall
- Dept. of Clinical Science and Technology, Karolinska Institutet, Stockholm, Sweden; Dept. of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anil K Chaturvedi
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Eva Munck-Wikland
- Dept. of Clinical Science and Technology, Karolinska Institutet, Stockholm, Sweden; Dept. of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Torbjörn Ramqvist
- Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bottai
- Dept. of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tina Dalianis
- Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
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Ramqvist T, Grün N, Dalianis T. Human papillomavirus and tonsillar and base of tongue cancer. Viruses 2015; 7:1332-43. [PMID: 25803099 PMCID: PMC4379573 DOI: 10.3390/v7031332] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/13/2015] [Accepted: 03/17/2015] [Indexed: 12/11/2022] Open
Abstract
In 2007, human papillomavirus (HPV) type 16 was recognized as a risk factor by the International Agency for Research on Cancer, for oropharyngeal squamous cell carcinoma (OSCC), where tonsillar and base of tongue cancer (TSCC and BOTSCC) dominate. Furthermore, patients with HPV-positive TSCC and BOTSCC, had a much better clinical outcome than those with corresponding HPV-negative cancer and other head and neck cancer. More specifically, survival was around 80% for HPV-positive TSCC and BOTSCC vs. 40% five-year disease free survival, for the corresponding HPV-negative tumors with conventional radiotherapy and surgery, while this could not be observed for HPV-positive OSCC at other sites. In addition, the past 20-40 years in many Western Countries, the incidence of HPV-positive TSCC and BOTSCC has risen, and >70% are men. This has resulted in a relative increase of patients with HPV-positive TSCC and BOTSCC that may not need the intensified chemo-radiotherapy (with many more severe debilitating side effects) often given today to patients with head and neck cancer. However, before tapering therapy, one needs to enable selection of patients for such treatment, by identifying clinical and molecular markers that together with HPV-positive status will better predict patient prognosis and response to therapy. To conclude, there is a new increasing group of patients with HPV-positive TSCC and BOTSCC with good clinical outcome, where options for better-tailored therapy are needed. For prevention, it would be of benefit to vaccinate both girls and boys against HPV16 infection. For potential future screening the ways to do so need optimizing.
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Affiliation(s)
- Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska R8:01, Karolinska University Hospital, 171 76 Stockholm, Sweden.
| | - Nathalie Grün
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska R8:01, Karolinska University Hospital, 171 76 Stockholm, Sweden.
| | - Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska R8:01, Karolinska University Hospital, 171 76 Stockholm, Sweden.
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Tertipis N, Haeggblom L, Grün N, Nordfors C, Näsman A, Dalianis T, Ramqvist T. Reduced Expression of the Antigen Processing Machinery Components TAP2, LMP2, and LMP7 in Tonsillar and Base of Tongue Cancer and Implications for Clinical Outcome. Transl Oncol 2015; 8:10-7. [PMID: 25749172 PMCID: PMC4350639 DOI: 10.1016/j.tranon.2014.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/27/2014] [Accepted: 11/03/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES: Patients with human papillomavirus (HPV)–positive tonsillar squamous cell carcinoma (TSCC) and base of tongue squamous cell carcinoma (BOTSCC) have a better clinical outcome than those with corresponding HPV-negative tumors. Moreover, there is a strong positive correlation between absent/low as opposed to strong HLA class I expression and favorable clinical outcome for HPV-positive tumors, while the reverse applies to HPV-negative tumors. The expression of the antigen processing machinery (APM) components TAP1, TAP2, LMP2, and LMP7 in these tumors in relation to HPV status, HLA class I expression, each other, and clinical outcome was therefore investigated. MATERIAL AND METHODS: Formalin-fixed paraffin-embedded TSCC and BOTSCC, derived from 151 patients and previously analyzed for HPV DNA, HLA class I, and LMP10 expression were stained by immunohistochemistry for TAP1, TAP2, LMP2, and LMP7. RESULTS: Absent/low TAP2, LMP2, and LMP7 expression, similar to HLA class I and LMP10, was common in TSCC and BOTSCC, irrespective of HPV status. Expression of TAP1 and TAP2 was correlated, as was LMP2 to LMP7. LMP2 and LMP7 expression was also associated to HLA class I expression. Moreover, absence of LMP7 was linked to increased disease-free survival in both HPV-positive and HPV-negative cases. CONCLUSION: Reduced expression of TAP2, LMP2, and LMP7 was frequent in TSCC and BOTSCC and their expression as well as that of TAP1 was often interrelated. Furthermore, low LMP7 expression correlated to better clinical outcome and may, together with HPV status, potentially be used for prediction of treatment response.
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Affiliation(s)
- Nikolaos Tertipis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Linnea Haeggblom
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Nathalie Grün
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Nordfors
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Näsman
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
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Abstract
Numerous reports in recent decades have shown that, in addition to smoking and alcohol, human papillomavirus (HPV) is also associated with the development of oropharyngeal squamous cell carcinoma (OPSCC), predominantly in the tonsils and base of the tongue. In 2007, the International Agency on Research against Cancer (IARC) therefore declared HPV to be a risk factor for OPSCC and noted that 80% of those affected are men. In addition, patients with HPV-positive OPSCC, in particular never-smokers, have a much better clinical response to therapy than patients with HPV-negative OPSCC and other head and neck cancers. Most patients with HPV-positive OPSCC may thus not need the increasingly intensive chemo-radiotherapy currently administered today to most patients with head neck cancers and associated with many adverse effects. Furthermore, an increase in the incidence of OPSCC has been observed in many western countries, accompanied by a rise in the proportion of HPV-positive tumors. Patients with HPV-positive OPSCC, like those with cervical cancer, more often have an earlier sexual debut and have more sexual partners. It has therefore been proposed that the increased incidence of OPSCC observed might be due to an epidemic of sexually transmitted HPV. The important issues today regarding this growing cohort of patients with HPV-positive OPSCC are therefore individualized treatment and prevention. More specifically, selected HPV-positive OPSCC patients with biomarkers of good prognosis might be included in randomized trials with less intensive treatment. HPV vaccination should also be considered for boys, in addition to the current recommendations for immunization of girls.
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Affiliation(s)
- Tina Dalianis
- Karolinska Institutet, Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska University Hospital, 17176 Stockholm, Sweden.
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Grün N, Ährlund-Richter A, Franzén J, Mirzaie L, Marions L, Ramqvist T, Dalianis T. Oral human papillomavirus (HPV) prevalence in youth and cervical HPV prevalence in women attending a youth clinic in Sweden, a follow up-study 2013-2014 after gradual introduction of public HPV vaccination. Infect Dis (Lond) 2014; 47:57-61. [PMID: 25378085 DOI: 10.3109/00365548.2014.964764] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
During 2009-2011, we reported that the oral and cervical prevalence of human papillomavirus (HPV) was high by international standards at 9.3% and 74%, respectively, in youth aged 15-23 years attending a youth clinic in Stockholm. After gradual introduction of public HPV vaccination during 2007-2012, between 2013 and 2014, when 73% of the women were HPV-vaccinated, but not necessarily before their sexual debut, oral HPV prevalence had dropped to 1.4% as compared with 9.3% in 2009-2011 (p < 0.00001). Cervical HPV prevalence was high and common cervical high-risk types were HPV51, 56, 59, 73, 16, 39, 52, and 53. However, it was shown that HPV16, 31, and 70 were significantly less common among HPV-vaccinated women than among those who had not received the vaccine.
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Affiliation(s)
- Nathalie Grün
- From the Department of Oncology-Pathology, Karolinska Institutet , Stockholm , Sweden
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Tertipis N, Villabona L, Nordfors C, Näsman A, Ramqvist T, Vlastos A, Masucci G, Dalianis T. HLA-A*02 in relation to outcome in human papillomavirus positive tonsillar and base of tongue cancer. Anticancer Res 2014; 34:2369-2375. [PMID: 24778045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND/AIM Patients with human papillomavirus (HPV)-positive tonsillar and base of tongue cancer have a better outcome than those with corresponding HPV-negative tumors (80% vs. 40% 5-year disease free survival with conventional radiotherapy). They should not all need chemoradiotherapy, but before tapering treatment, more markers are needed to predict treatment response. In the present study, human leukocyte antigen (HLA) - HLA-A*02 was analyzed with HPV as a prognostic factor for tonsillar and base of tongue cancer. PATIENTS AND METHODS Pre-treatment biopsies, previously tested for HPV DNA, from 425 patients diagnosed with tonsillar and base of tongue cancer between 2000-2009 at the Karolinska University Hospital were examined for HLA-A*02. RESULTS HLA-A*02 was present in 144/305 (47.2%) of the HPV-positive and 63/120 (52.8%) of the HPV-negative tumours. Among 383 patients treated with curative intent, absence of HLA-A*02 was correlated with increased disease-free survival in the HPV-positive (p=0.016), but not in the HPV-negative group. CONCLUSION Absence of HLA-A*02 correlated with better disease-free survival for patients with HPV-positive tonsillar and base of tongue cancer.
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Affiliation(s)
- Nikolaos Tertipis
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska, R8:01 Karolinska University Hospital, 171 76 Stockholm, Sweden.
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Tertipis N, Haeggblom L, Nordfors C, Grün N, Näsman A, Vlastos A, Dalianis T, Ramqvist T. Correlation of LMP10 expression and clinical outcome in Human Papillomavirus (HPV) positive and HPV-Negative tonsillar and base of tongue cancer. PLoS One 2014; 9:e95624. [PMID: 24752327 PMCID: PMC3994073 DOI: 10.1371/journal.pone.0095624] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 03/27/2014] [Indexed: 12/11/2022] Open
Abstract
AIM To examine LMP10 expression and its possible impact on clinical outcome in human papillomavirus (HPV) positive and HPV-negative tonsillar and base of tongue squamous cell carcinoma (TSCC and BOTSCC). BACKGROUND Outcome is better in HPV-positive TSCC and BOTSCC compared to matching HPV-negative tumours, with roughly 80% vs. 40% 5-year disease free survival (DFS) with less aggressive treatment than today's chemoradiotherapy. Since current treatment often results in harmful side effects, less intensive therapy, with sustained patient survival would be an attractive alternative. However, other markers together with HPV status are necessary to select patients and for this purpose LMP10 expression is investigated here in parallel to HPV status and clinical outcome. MATERIALS AND METHODS From 385 patients diagnosed between 2000 and 2007 at the Karolinska University Hospital, 278 formalin fixed paraffin embedded TSCC and BOTSCC biopsies, with known HPV DNA status, were tested for LMP10 nuclear and cytoplasmic expression (fraction of positive cells and staining intensity). The data was then correlated to clinical outcome. RESULTS An absent/low compared to a moderate/high LMP10 nuclear fraction of positive cells was correlated to a better 3-year DFS in the HPV-positive group of patients (log-rank p = 0.005), but not in the HPV-negative group. In the HPV-negative group of patients, in contrast to the HPV-positive group, moderate/high LMP10 cytoplasmic fraction and weak/moderate/high LMP10 cytoplasmic intensity correlated to a better 3-year DFS (p = 0.003 and p = 0.001) and 3-year overall survival (p = 0.001 and 0.009). CONCLUSION LMP10 nuclear expression in the HPV-positive group and LMP10 cytoplasmic expression in the HPV-negative group of patients correlated to better clinical outcome.
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Affiliation(s)
- Nikolaos Tertipis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Linnea Haeggblom
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Nordfors
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Nathalie Grün
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Näsman
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Vlastos
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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Nordfors C, Vlastos A, Du J, Ahrlund-Richter A, Tertipis N, Grün N, Romanitan M, Haeggblom L, Roosaar A, Dahllöf G, Donà MG, Benevolo M, Ramqvist T, Munck-Wikland E, Dalianis T. Human papillomavirus prevalence is high in oral samples of patients with tonsillar and base of tongue cancer. Oral Oncol 2014; 50:491-7. [PMID: 24613649 DOI: 10.1016/j.oraloncology.2014.02.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/24/2014] [Accepted: 02/05/2014] [Indexed: 01/28/2023]
Abstract
MATERIAL AND METHODS Presence of HPV DNA was analyzed in mouthwash and tonsillar swab samples, if indicative of HPV-positive tonsillar or base of tongue cancer in 76 patients, with suspected head neck cancer, undergoing diagnostic endoscopy at Karolinska University Hospital. The diagnosis and tumor HPV status was later obtained from patients' records. As controls, 37 tumor-free dental visitors were included. RESULTS Of the 76 patients, 22/29 (76%) and 16/18 (89%) had an HPV-positive tonsillar and base of tongue cancer respectively, with 18/22 (82%) and 8/16 (50%) respectively having tumor concordant HPV-type positive oral samples. Two other HPV-positive oral samples in the base of tongue cancer group did not correlate to the tumor HPV status. Among the remaining patients, 19 with other head neck cancer and 10 with benign conditions, 4/29 (14%) had HPV-positive oral samples. Consequently, of the HPV-positive oral samples, dominated by HPV16 and high signals, 27/32 (84%) were derived from 26 patients with concordant HPV-type positive tonsillar or base of tongue cancer and one patient with an unknown primary head and neck cancer. The other five HPV-positive oral samples, with mainly low signals were derived from two patients with non-concordant HPV-type positive tumor biopsies, two patients with HPV-negative tumor biopsies and a patient with a benign condition. Of the dental patients, 3/37 (8%) had HPV-positive tonsillar swabs with weak signals. CONCLUSION In patients with suspected head neck cancer, HPV-positive oral samples, especially HPV16 with high signals, could be indicative of HPV-positive tonsillar or base of tongue cancer.
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Affiliation(s)
- Cecilia Nordfors
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Vlastos
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Oto-Rhino-Laryngology, Head and Neck Surgery, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Sweden
| | - Juan Du
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Ahrlund-Richter
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nikolaos Tertipis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Nathalie Grün
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Mircea Romanitan
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Audiology and Neurotology CLINTEC, Karolinska Institutet, Karolinska University Hospital, Sweden
| | - Linnea Haeggblom
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Ann Roosaar
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Göran Dahllöf
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Maria Benevolo
- Pathology Department, Regina Elena National Cancer Institute, Rome, Italy
| | - Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Eva Munck-Wikland
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Sweden
| | - Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
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Mattebo M, Grün N, Rosenblad A, Larsson M, Häggström-Nordin E, Dalianis T, Tydén T. Sexual experiences in relation to HPV vaccination status in female high school students in Sweden. EUR J CONTRACEP REPR 2014; 19:86-92. [PMID: 24555926 DOI: 10.3109/13625187.2013.878021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To investigate sexual experiences, sexually transmitted infections (STIs) and use of condoms in relation to human papillomavirus (HPV)-vaccination status in female high school students. METHODS In 2013, 355 female students with a median age of 18 years from randomly selected high schools in Sweden answered a classroom questionnaire on sexual experiences and HPV-vaccination status. RESULTS In total 227/348 (65%) of the women reported having received at least one HPV vaccine dose. Median age at first intercourse was 15 and 16 years respectively, in the 141/227 (62%) vaccinated after, and the 86/227 (38%) vaccinated before their sexual debut. There were no differences between the HPV-vaccinated and non-vaccinated groups regarding condom use, STIs, and experiences of oral and anal sex, or friends- with-benefit relationships. However, having had sexual intercourse and 'one-night stands' were more common in the vaccinated group (both p < 0.05). CONCLUSION Many students (62%) were vaccinated against HPV, with two-thirds after their sexual debut. There were no differences in condom use and STIs, and only a few differences in sexual experiences between the HPV-vaccinated and non-vaccinated groups. Initiating HPV vaccination before sexual debut is important, as is information about the link between HPV, sexual behaviour and cancer.
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Affiliation(s)
- Magdalena Mattebo
- * Department of Women's and Children's Health, Uppsala University , Uppsala
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74
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Lindquist D, Näsman A, Tarján M, Henriksson R, Tot T, Dalianis T, Hedman H. Expression of LRIG1 is associated with good prognosis and human papillomavirus status in oropharyngeal cancer. Br J Cancer 2014; 110:1793-800. [PMID: 24548859 PMCID: PMC3974094 DOI: 10.1038/bjc.2014.87] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 12/02/2013] [Accepted: 01/22/2014] [Indexed: 01/08/2023] Open
Abstract
Background: The incidence of human papillomavirus (HPV)-associated oropharyngeal cancer has increased rapidly during the past decades. HPV is typically associated with a favourable outcome; however, a need exists for new and more effective prognostic and predictive markers for this disease. Leucine-rich repeats and immunoglobulin-like domains (LRIG)-1 is a tumour suppressor protein that belongs to the LRIG family. LRIG1 expression has prognostic significance in various human cancers, including cervical cancer, where HPV is a key aetiological agent. Methods: The prognostic value of LRIG1 and LRIG2 immunoreactivity was investigated in tumour specimens from a Swedish cohort of patients with tonsillar and base of tongue oropharyngeal cancers, including 278 patients. Results: LRIG1 immunoreactivity correlated with disease-free survival and overall survival in univariate and multivariate analyses. Notably, patients with HPV-positive tumours with high LRIG1 staining intensity or a high percentage of LRIG1-positive cells showed a very good prognosis. Furthermore, LRIG1 expression correlated with HPV status, whereas LRIG2 expression inversely correlated with HPV status. Conclusions: Taken together, the results suggest that LRIG1 immunoreactivity could be a clinically important prognostic marker in HPV-associated oropharyngeal cancer.
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Affiliation(s)
- D Lindquist
- Department of Radiation Sciences, Umeå University, SE-901 87, Umeå, Sweden
| | - A Näsman
- Department of Oncology-Pathology, Karolinska Institute, SE-171 76, Stockholm, Sweden
| | - M Tarján
- Department of Pathology and Clinical Cytology, Central Hospital Falun, SE-791 29, Falun, Sweden
| | - R Henriksson
- Department of Radiation Sciences, Umeå University, SE-901 87, Umeå, Sweden
| | - T Tot
- Department of Pathology and Clinical Cytology, Central Hospital Falun, SE-791 29, Falun, Sweden
| | - T Dalianis
- Department of Oncology-Pathology, Karolinska Institute, SE-171 76, Stockholm, Sweden
| | - H Hedman
- Department of Radiation Sciences, Umeå University, SE-901 87, Umeå, Sweden
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75
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Sivars L, Näsman A, Tertipis N, Vlastos A, Ramqvist T, Dalianis T, Munck-Wikland E, Nordemar S. Human papillomavirus and p53 expression in cancer of unknown primary in the head and neck region in relation to clinical outcome. Cancer Med 2014; 3:376-84. [PMID: 24510528 PMCID: PMC3987086 DOI: 10.1002/cam4.199] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 11/28/2013] [Accepted: 01/01/2014] [Indexed: 12/13/2022] Open
Abstract
Patients with cancer of unknown primary (CUP) in the head neck region are generally treated with neck dissection followed by radiotherapy at times combined with chemotherapy, a treatment associated with considerable side effects. Some of these tumors may originate as human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OSCC), with better clinical outcome than head neck squamous cell cancer (HNSCC) in general, and could potentially do well with less treatment. Here, we therefore investigated whether HPV status and p53-expression correlated to clinical outcome in patients with CUP in the head neck region. Fifty metastases were analyzed for presence of HPV DNA, and expression of p16INK4A and p53 and the data were correlated to clinical outcome. Patients with HPV DNA-positive (HPVDNA+) metastases had significantly better 5-year overall survival (OS) compared to those with HPVDNA− metastases (80.0% vs. 36.7%, respectively; P = 0.004), with a similar tendency for disease-free survival (DFS). These survival rates showed excellent concordance with those of HPVDNA+ and HPVDNA− OSCC in Sweden during the same time period, strengthening the hypothesis that HPVDNA+ head and neck CUP may originate from HPVDNA+ OSCC. In addition, having absent/intermediary-low as compared to high expression of p53 correlated to a better prognosis with a 69% as compared to 14% 5-year OS, respectively (P < 0.001), and for DFS the tendency was analogous. In conclusion, both HPV status and p53 expression are valuable prognostic factors in patients with CUP in the head and neck region and should be further explored for clinical use.
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Affiliation(s)
- Lars Sivars
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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76
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Ramqvist T, Nordfors C, Dalianis T, Ragnarsson-Olding B. DNA from human polyomaviruses, TSPyV, MWPyV, HPyV6, 7 and 9 was not detected in primary mucosal melanomas. Anticancer Res 2014; 34:639-643. [PMID: 24510993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND/AIM Mucosal melanomas arise in non UV-light exposed areas and causative factors are yet unknown. Human polyomaviruses (HPyVs) are rapidly increasing in numbers and are potentially oncogenic, as has been established for MCPyV in Merkel cell carcinoma, an unusual skin cancer type. The aim of the present study was to investigate the association between TSPyV, MWPyV, HPyV6, 7 and 9 and mucosal melanoma. MATERIALS AND METHODS Fifty-five mucosal melanomas, were analyzed by a Luminex assay, for the presence of 10 HPyVs (BKPyV, JCPyV, KIPyV, WUPyV, TSPyV, MWPyV, HPyV6, 7 and 9) and two primate viruses (SV40 and LPyV). RESULTS In 37 samples the DNA quality was satisfactory for analysis. However, none of the samples analyzed were positive for any of the examined viruses. CONCLUSION None of the above-analyzed HPyVs were detected in mucosal melanoma samples, and they are for this reason unlikely to play a major role in the development of this tumor type.
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Affiliation(s)
- Torbjörn Ramqvist
- Department Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital CCK R8:01, SE-171 76 Stockholm, Sweden.
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77
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Nordfors C, Grün N, Haeggblom L, Tertipis N, Sivars L, Mattebo M, Larsson M, Häggström-Nordin E, Tydén T, Ramqvist T, Dalianis T. Oral human papillomavirus prevalence in high school students of one municipality in Sweden. Scandinavian Journal of Infectious Diseases 2013; 45:878-81. [PMID: 23957537 DOI: 10.3109/00365548.2013.821626] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The rise in human papillomavirus (HPV) infection has been suggested to be responsible for the increased incidence of oropharyngeal cancer in the Western world. This has boosted interest in oral HPV prevalence and whether HPV vaccines can prevent oral HPV infection. In a previous study we showed oral HPV prevalence to be almost 10% in youth aged 15-23 y attending a youth clinic in Stockholm, Sweden. However, this may not be a generalizable sample within the Swedish population. Therefore, mouthwashes were used to investigate oral HPV prevalence in 335 Swedish high school students aged 17-21 y (median age 18 y), from 1 municipality with 140,000 inhabitants. The presence of HPV DNA in the oral samples, as examined by a Luminex-based assay, was significantly lower in this cohort, only 1.8% (3.1% in females and 0.6% in males), as compared to our previous study.
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Affiliation(s)
- Cecilia Nordfors
- From the Department of Oncology-Pathology, Karolinska Institutet , Stockholm
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78
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Näsman A, Andersson E, Marklund L, Tertipis N, Hammarstedt-Nordenvall L, Attner P, Nyberg T, Masucci GV, Munck-Wikland E, Ramqvist T, Dalianis T. HLA class I and II expression in oropharyngeal squamous cell carcinoma in relation to tumor HPV status and clinical outcome. PLoS One 2013; 8:e77025. [PMID: 24130830 PMCID: PMC3794938 DOI: 10.1371/journal.pone.0077025] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/26/2013] [Indexed: 01/01/2023] Open
Abstract
HPV-DNA positive (HPVDNA+) oropharyngeal squamous cell carcinoma (OSCC) has better clinical outcome than HPV-DNA negative (HPVDNA-) OSCC. Current treatment may be unnecessarily extensive for most HPV+ OSCC, but before de-escalation, additional markers are needed together with HPV status to better predict treatment response. Here the influence of HLA class I/HLA class II expression was explored. Pre-treatment biopsies, from 439/484 OSCC patients diagnosed 2000-2009 and treated curatively, were analyzed for HLA I and II expression, p16(INK4a) and HPV DNA. Absent/weak as compared to high HLA class I intensity correlated to a very favorable disease-free survival (DFS), disease-specific survival (DSS) and overall survival (OS) in HPVDNA+ OSCC, both in univariate and multivariate analysis, while HLA class II had no impact. Notably, HPVDNA+ OSCC with absent/weak HLA class I responded equally well when treated with induction-chemo-radiotherapy (CRT) or radiotherapy (RT) alone. In patients with HPVDNA- OSCC, high HLA class I/class II expression correlated in general to a better clinical outcome. p16(INK4a) overexpression correlated to a better clinical outcome in HPVDNA+ OSCC. Absence of HLA class I intensity in HPVDNA+ OSCC suggests a very high survival independent of treatment and could possibly be used clinically to select patients for randomized trials de-escalating therapy.
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Affiliation(s)
- Anders Näsman
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Emilia Andersson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Linda Marklund
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Nikolaos Tertipis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Lalle Hammarstedt-Nordenvall
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Per Attner
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Tommy Nyberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | | | - Eva Munck-Wikland
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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Wendt M, Romanitan M, Näsman A, Dalianis T, Hammarstedt L, Marklund L, Ramqvist T, Munck-Wikland E. Presence of human papillomaviruses and p16 expression in hypopharyngeal cancer. Head Neck 2013; 36:107-12. [DOI: 10.1002/hed.23394] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 03/24/2013] [Accepted: 05/21/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Malin Wendt
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Mircea Romanitan
- Department of Oncology-Pathology, Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Anders Näsman
- Department of Oncology-Pathology, Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Lalle Hammarstedt
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Linda Marklund
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Eva Munck-Wikland
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
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80
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Gustafsson B, Priftakis P, Rubin J, Giraud G, Ramqvist T, Dalianis T. Human polyomaviruses were not detected in cerebrospinal fluid of patients with neurological complications after hematopoietic stem cell transplantation. Future Virol 2013. [DOI: 10.2217/fvl.13.55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Neurological complications after allogeneic hematopoietic stem cell transplantation (HSCT) are associated with increased mortality. Reactivation of JC virus, a well-known human polyomavirus (HPyV), can be associated with progressive multifocal leukoencephalopathy after HSCT. Aim: To investigate whether reactivation of the newly discovered HPyVs KIPyV, WUPyV, Merkel cell polyomavirus, HPyV6, HPyV7, trichodysplasia spinulosa polyomavirus, HPyV9 or HPyV10 (MWPyV) is associated with neurological complications after HSCT. Materials & methods: Cerebrospinal fluid from 32 HSCT patients with neurological symptoms was analyzed for the presence of the above HPyVs, including BK virus and JC virus, as well as the primate polyomaviruses lymphotropic polyomavirus and simian virus 40. Results & conclusion: No HPyV DNA was detected or associated with the neurological symptoms the patients showed post-HSCT.
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Affiliation(s)
- Britt Gustafsson
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital-Huddinge, Department of Clinical Science, Intervention & Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
| | - Peter Priftakis
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital-Huddinge, Department of Clinical Science, Intervention & Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Johanna Rubin
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital-Huddinge, Department of Clinical Science, Intervention & Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Geraldine Giraud
- Mälarsjukhuset, Eskilstuna, Sweden
- Department of Oncology–Pathology, Karolinska Institutet, Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Torbjörn Ramqvist
- Department of Oncology–Pathology, Karolinska Institutet, Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Tina Dalianis
- Department of Oncology–Pathology, Karolinska Institutet, Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
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81
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Jamil S, Cedervall J, Hultman I, Ali R, Margaryan NV, Rasmuson A, Johnsen JI, Sveinbjörnsson B, Dalianis T, Kanter L, Orrego A, Strizzi L, Hendrix MJC, Sandstedt B, Kogner P, Ahrlund-Richter L. Neuroblastoma cells injected into experimental mature teratoma reveal a tropism for embryonic loose mesenchyme. Int J Oncol 2013; 43:831-8. [PMID: 23857308 DOI: 10.3892/ijo.2013.2014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 06/26/2013] [Indexed: 11/06/2022] Open
Abstract
Embryonic neural tumors are responsible for a disproportionate number of cancer deaths in children. Although dramatic improvements in survival for pediatric malignancy has been achieved in previous years advancements seem to be slowing down. For the development of new enhanced therapy and an increased understanding of the disease, pre-clinical models better capturing the neoplastic niche are essential. Tumors of early childhood present in this respect a particular challenge. Here, we explore how components of the embryonic process in stem‑cell induced mature teratoma can function as an experimental in vivo microenvironment instigating the growth of injected childhood neuroblastoma (NB) cell lines. Three human NB cell lines, IMR-32, Kelly and SK-N-BE(2), were injected into mature pluripotent stem cell‑induced teratoma (PSCT) and compared to xenografts of the same cell lines. Proliferative NB cells from all lines were readily detected in both models with a typical histology of a poorly differentiated NB tumor with a variable amount of fibrovascular stroma. Uniquely in the PSCT microenvironment, NB cells were found integrated in a non‑random fashion. Neuroblastoma cells were never observed in areas with well-differentiated somatic tissue i.e. bone, muscle, gut or areas of other easily identifiable tissue types. Instead, the three cell lines all showed initial growth exclusively occurring in the embryonic loose mesenchymal stroma, resulting in a histology recapitulating NB native presentation in vivo. Whether this reflects the 'open' nature of loose mesenchyme more easily giving space to new cells compared to other more dense tissues, the rigidity of matrix providing physical cues modulating NB characteristics, or if embryonic loose mesenchyme may supply developmental cues that attracted or promoted the integration of NB, remains to be tested. We tentatively hypothesize that mature PSCT provide an embryonic niche well suited for in vivo studies on NB.
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Affiliation(s)
- S Jamil
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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82
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Nordfors C, Grün N, Tertipis N, Ährlund-Richter A, Haeggblom L, Sivars L, Du J, Nyberg T, Marklund L, Munck-Wikland E, Näsman A, Ramqvist T, Dalianis T. CD8+ and CD4+ tumour infiltrating lymphocytes in relation to human papillomavirus status and clinical outcome in tonsillar and base of tongue squamous cell carcinoma. Eur J Cancer 2013; 49:2522-30. [DOI: 10.1016/j.ejca.2013.03.019] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 03/07/2013] [Accepted: 03/09/2013] [Indexed: 02/02/2023]
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83
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Näsman A, Nordfors C, Grün N, Munck-Wikland E, Ramqvist T, Marklund L, Lindquist D, Dalianis T. Absent/weak CD44 intensity and positive human papillomavirus (HPV) status in oropharyngeal squamous cell carcinoma indicates a very high survival. Cancer Med 2013; 2:507-18. [PMID: 24156023 PMCID: PMC3799285 DOI: 10.1002/cam4.90] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/03/2013] [Accepted: 04/04/2013] [Indexed: 12/11/2022] Open
Abstract
Patients with human papillomavirus DNA positive (HPVDNA+) oropharyngeal squamous cell carcinoma (OSCC) have better clinical outcome than those with HPV DNA negative (HPVDNA−) OSCC upon intensive oncological treatment. All HPVDNA+ OSCC patients may not require intensive treatment, however, but before potentially deintensifying treatment, additional predictive markers are needed. Here, we examined HPV, p16INK4a, and CD44 in OSCC in correlation to clinical outcome. Pretreatment tumors from 290 OSCC patients, the majority not receiving chemotherapy, were analyzed for HPV DNA by Luminex and for p16INK4a and CD44 by immunohistochemistry. 225/290 (78%) tumors were HPVDNA+ and 211/290 (73%) overexpressed p16INK4a, which correlated to presence of HPV (P < 0.0001). Presence of HPV DNA, absent/weak CD44 intensity staining correlated to favorable 3-year disease-free survival (DFS) and overall survival (OS) by univariate and multivariate analysis, and likewise for p16INK4a by univariate analysis. Upon stratification for HPV, HPVDNA+ OSCC with absent/weak CD44 intensity presented the significantly best 3-year DFS and OS, with >95% 3-year DFS and OS. Furthermore, in HPVDNA+ OSCC, p16INK4a+ overexpression correlated to a favorable 3-year OS. In conclusion, patients with HPVDNA+ and absent/weak CD44 intensity OSCC presented the best survival and this marker combination could possibly be used for selecting patients for tailored deintensified treatment in prospective clinical trials. Absence of/weak CD44 or presence of human papillomavirus (HPV) DNA was shown as a favorable prognostic factors in tonsillar and tongue base cancer. Moreover, patients with the combination of absence of/weak CD44 and presence of HPV DNA presented a very favorable outcome. Therefore, we suggest that this marker combination could potentially be used to single out patients with a high survival that could benefit from a de-escalated oncological treatment.
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Affiliation(s)
- Anders Näsman
- Department of Oncology-Pathology, Karolinska Institutet Stockholm, Sweden
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84
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Romanitan M, Näsman A, Munck-Wikland E, Dalianis T, Ramqvist T. EGFR and phosphorylated EGFR in relation to HPV and clinical outcome in tonsillar cancer. Anticancer Res 2013; 33:1575-1583. [PMID: 23564800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) is a risk factor for tonsillar squamous cell carcinoma (TSCC) and the presence of HPV is correlated to a better clinical outcome. To find additional biomarkers that, together with HPV, predict clinical outcome, the aim of the present study was to evaluate epidermal growth factor receptor (EGFR) and phosphorylated EGFR (pEGFR) in relation to HPV status and clinical outcome. MATERIALS AND METHODS A total of 83 pre-treatment TSCC biopsies were analyzed for EGFR and pEGFR Tyr1068 and Tyr1148 by immunohistochemistry, and the obtained data were tested for correlation to tumor HPV status and disease-free survival. RESULTS The presence of pEGFR Tyr1068 and 1148, both correlated significantly to the absence of HPV. However, neither of these, nor total EGFR, correlated significantly to disease-free survival for HPV-positive or HPV-negative TSCC. CONCLUSION Since pEGFR Tyr1068 and 1148 are correlated to absence of HPV but not to clinical outcome, these may not be optimal prognostic markers for clinical outcome in patients with TSCC.
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Affiliation(s)
- Mircea Romanitan
- Departments of Oncology-Pathology, Head and Neck Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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85
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Abstract
Today the human polyomavirus (HPyV) family consists of 10 members, BK virus (BKV) and JC virus (JCV) isolated 40 years ago and the more recently identified KI virus (KIPyV), WU virus (WUPyV), Merkel cell polyomavirus (MCPyV), HPyV6, HPyV7, trichodysplasia spinulosa virus (TSPyV), HPyV9 and MWPyV. Serological studies suggest that HPyVs subclinically infect the general population with rates ranging from 35% to 90%. However, significant disease is only observed in patients with impaired immune functions. Thus, BKV has been linked to hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation and PyV-associated nephropathy (PyVAN) after kidney transplantation; JCV to progressive multifocal leukoencephalopathy (PML) in HIV-AIDS, hematological diseases and in autoimmune diseases treated with certain lymphocyte-specific antibodies. KIPyV and WUPyV have been found in the respiratory tract, HPyV6 and 7 in the skin, and HPyV9 in serum and skin, and MWPyV in stools and skin, but so far none of these PyVs have been linked to any disease. TSPyV, on the other hand, was identified in trichodysplasia spinulosa, a rare skin disease characterized by virus-induced lytic as well as proliferative tumor-like features that is observed in immune-suppressed transplant patients. In contrast to all the other HPyVs so far, MCPyV is unique in its association with a cancer, Merkel cell carcinoma, which is a rare skin cancer arising in the elderly and chronically immunosuppressed individuals. The discovery of the new HPyVs has revived interest in the Polyomaviridae and their association to human disease and cancer. In this review, we summarize knowledge about this expanding family of human pathogens.
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Affiliation(s)
- Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska R8:01, Karolinska University Hospital, 171 76 Stockholm, Sweden.
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86
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Du J, Nordfors C, Ahrlund-Richter A, Sobkowiak M, Romanitan M, Näsman A, Andersson S, Ramqvist T, Dalianis T. Prevalence of oral human papillomavirus infection among youth, Sweden. Emerg Infect Dis 2013; 18:1468-71. [PMID: 22932445 PMCID: PMC3437726 DOI: 10.3201/eid1809.111731] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Human papillomavirus (HPV) causes cervical, head, and neck cancers. We studied 483 patients at a youth clinic in Stockholm, Sweden, and found oral HPV prevalence was 9.3% and significantly higher for female youth with than without cervical HPV infection (p = 0.043). Most oral HPV types matched the co-occurring cervical types.
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Affiliation(s)
- Juan Du
- Karolinska Institutet, Stockholm, Sweden
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Löfdahl HE, Du J, Näsman A, Andersson E, Rubio CA, Lu Y, Ramqvist T, Dalianis T, Lagergren J, Dahlstrand H. Prevalence of human papillomavirus (HPV) in oesophageal squamous cell carcinoma in relation to anatomical site of the tumour. PLoS One 2012; 7:e46538. [PMID: 23077513 PMCID: PMC3470583 DOI: 10.1371/journal.pone.0046538] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 08/31/2012] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The prevalence and role of human papillomavirus (HPV) in the aetiology of oesophageal squamous cell carcinoma is uncertain. Based on the presence of HPV in the oral cavity and its causal association with squamous cell carcinoma of the oropharynx, we hypothesised that HPV is more strongly associated with proximal than distal oesophageal squamous cell carcinoma. METHODS A population-based study comparing HPV infection in relation to tumour site in patients diagnosed with oesophageal squamous cell carcinomas in the Stockholm County in 1999-2006. Multiplex polymerase chain reaction genotyping (PCR) with Luminex was conducted on pre-treatment endoscopic biopsies to identify type specify HPV. Carcinogenic activity of HPV was assessed by p16(INK4a) expression. Multivariable logistic regression was used to calculate odds ratios and 95% confidence intervals. RESULTS Among 204 patients, 20 (10%) had tumours harbouring HPV DNA, almost all (90%) of HPV high-risk type, mainly HPV16. Tumours containing HPV were not overrepresented in the upper compared to the middle or lower third of the oesophagus (odds ratio 0.6, 95% confidence interval 0.2-1.9). P16(INK4a) expression was similarly common (24% and 16%) in the HPV-positive and HPV-negative groups. CONCLUSION This study found a limited presence of HPV in oesophageal squamous cell carcinoma of uncertain oncogenic relevance and did not demonstrate that HPV was more strongly associated with proximal than distal tumours.
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Affiliation(s)
- Hedvig E Löfdahl
- Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Näsman A, Andersson E, Nordfors C, Grün N, Johansson H, Munck-Wikland E, Massucci G, Dalianis T, Ramqvist T. MHC class I expression in HPV positive and negative tonsillar squamous cell carcinoma in correlation to clinical outcome. Int J Cancer 2012; 132:72-81. [DOI: 10.1002/ijc.27635] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 04/24/2012] [Indexed: 12/11/2022]
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Marklund L, Näsman A, Ramqvist T, Dalianis T, Munck-Wikland E, Hammarstedt L. Prevalence of human papillomavirus and survival in oropharyngeal cancer other than tonsil or base of tongue cancer. Cancer Med 2012; 1:82-8. [PMID: 23342257 PMCID: PMC3544432 DOI: 10.1002/cam4.2] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 03/06/2012] [Accepted: 03/23/2012] [Indexed: 02/03/2023] Open
Abstract
Today, most oropharyngeal squamous cell carcinoma (OSCC) is human papillomavirus (HPV) positive and HPV alone or in combination with p16 is reported to be a favorable prognostic factor for OSCC. Patients with tumors at other OSCC sites (OOSCC) are often included in the same treatment and study protocols as patients with tonsillar- and base of tongue SCC, even though the prevalence and clinical significance of HPV infection in OOSCC is unknown. Since tonsillar and base of tongue SSC cover roughly 90% of all OSCC, there is an obvious risk that there may be a misinterpretation of the results for OOSCC. Herein, we therefore study the prevalence of HPV and p16 and their impact on survival in OOSCC. A total of 69 patients were included in the study, and 61 were included in the survival analysis. HPV and p16 were present in only 17% (12/69) and 25% (17/69) of the OOSCC cases, respectively, while the majority 69% (48/69) was both HPV and p16 negative. Neither HPV nor p16 had predictive value for clinical outcome in OOSCC in this study. In conclusion, the prevalence of HPV and/or p16 is much lower in OOSCC compared to earlier reports including all OSCC, or tonsillar- and base of tongue cancer alone and HPV and p16 had no impact on clinical outcome in OSCC in this study. Our data highlight the diversity of head neck cancer sub-sites and the importance of taking OSCC sub-sites in consideration in future clinical trials and treatment.
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Affiliation(s)
- Linda Marklund
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska University Hospital, Karolinska Institutet Stockholm, Sweden.
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Abstract
Polyomaviruses are small DNA viruses present in mammals and birds, and in 1953 the first one to be described was murine polyomavirus. It was not until 1971 that the first two human polyomaviruses (HPyVs), BK virus and JC virus, were discovered and found to be common in humans, but only associated with disease in severely immunosuppressed patients. Since 2007, seven new HPyVs have been identified: KI polyomavirus, WU polyomavirus, Merkel cell polyomavirus, HPyV6, HPyV7, trichodyplasia spinulosa polyomavirus and HPyV9. Notably, Merkel cell polyomavirus was detected in Merkel cell cancer, a tumor mainly found in elderly and immunocompromised individuals, while trichodyplasia spinulosa polyomavirus was found in trichodyplasia spinulosa, a skin disorder observed only in immunosuppressed individuals. Consequently, many polyomaviruses cause problems in immunosuppressed individuals. This review deals with these issues, and the potential of the capsid protein VP1 to form virus-like particles for use as vaccines against polyomavirus infections.
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Affiliation(s)
- Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institute, Cancer Center Karolinska, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
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Du J, Nordfors C, Näsman A, Sobkowiak M, Romanitan M, Dalianis T, Ramqvist T. Human papillomavirus (HPV) 16 E6 variants in tonsillar cancer in comparison to those in cervical cancer in Stockholm, Sweden. PLoS One 2012; 7:e36239. [PMID: 22558401 PMCID: PMC3338690 DOI: 10.1371/journal.pone.0036239] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 03/29/2012] [Indexed: 01/08/2023] Open
Abstract
Background Human papillomavirus (HPV), especially HPV16, is associated with the development of both cervical and tonsillar cancer and intratype variants in the amino acid sequence of the HPV16 E6 oncoprotein have been demonstrated to be associated with viral persistence and cancer lesions. For this reason the presence of HPV16 E6 variants in tonsillar squamous cell carcinoma (TSCC) in cervical cancer (CC), as well as in cervical samples (CS), were explored. Methods HPV16 E6 was sequenced in 108 TSCC and 52 CC samples from patients diagnosed 2000–2008 in the County of Stockholm, and in 51 CS from young women attending a youth health center in Stockholm. Results The rare E6 variant R10G was relatively frequent (19%) in TSCC, absent in CC and infrequent (4%) in CS, while the well-known L83V variant was common in TSCC (40%), CC (31%), and CS (29%). The difference for R10G was significant between TSCC and CC (p = 0.0003), as well as between TSCC and CS (p = 0.009). The HPV16 European phylogenetic lineage and its derivatives dominated in all samples (>90%). Conclusion The relatively high frequency of the R10G variant in TSCC, as compared to what has been found in CC both in the present study as well as in several other studies in different countries, may indicate a difference between TSCC and CC with regard to tumor induction and development. Alternatively, there could be differences with regard to the oral and cervical prevalence of this variant that need to be explored further.
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Affiliation(s)
- Juan Du
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
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Lindquist D, Ahrlund-Richter A, Tarján M, Tot T, Dalianis T. Intense CD44 expression is a negative prognostic factor in tonsillar and base of tongue cancer. Anticancer Res 2012; 32:153-161. [PMID: 22213301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Patients with tonsillar and base of tongue cancer, which are human papillomavirus (HPV) positive, have a better clinical outcome than those with HPV-negative tumors. The identification of additional predictive markers for response to therapy could still be of great use. MATERIALS AND METHODS Tumor markers CD44, p16, epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), E-cadherin, cyclooxygenase-2 (COX 2), Ki-67, and p27 were analyzed by immunochemistry, and HPV status was tested by polymerase chain reaction (PCR) in tumors from 73 patients and correlated to survival. RESULTS High intensity CD44 staining (p=0.006) and high EGFR expression (p=0.026) were indicators of poor prognosis, while high p16 expression (p=0.021) and younger age (p=0.002) were positive prognostic markers for disease-specific survival. Furthermore, staining of CD44 (p=0.026) and age (p=0.002) were shown to be strong prognostic markers in multivariate analysis, which should be evaluated further for possible use in clinical practice.
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Attner P, Näsman A, Du J, Hammarstedt L, Ramqvist T, Lindholm J, Munck-Wikland E, Dalianis T, Marklund L. Survival in patients with human papillomavirus positive tonsillar cancer in relation to treatment. Int J Cancer 2011; 131:1124-30. [DOI: 10.1002/ijc.26490] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 10/06/2011] [Indexed: 11/07/2022]
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Du J, Näsman A, Carlson JW, Ramqvist T, Dalianis T. Prevalence of human papillomavirus (HPV) types in cervical cancer 2003-2008 in Stockholm, Sweden, before public HPV vaccination. Acta Oncol 2011; 50:1215-9. [PMID: 21726177 DOI: 10.3109/0284186x.2011.584556] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) infection is the major cause of cervical cancer, but the prevalence of different HPV types varies depending on geographical location and may change dramatically after introduction of HPV vaccination. Here, we aimed to gain some information regarding the recent prevalence of different HPV types, in cancer of the uterine cervix in the Stockholm region, before the introduction of public HPV vaccination in Sweden. MATERIAL AND METHODS From 215 diagnosed cervical cancer patients 2003-2008 at the Karolinska University Hospital, 160 pretreatment cervical cancer samples, including both squamous cell carcinomas (SCC) and adenocarcinomas (ADC) could be obtained. DNA was extracted from 154/160 of the SCC and ADC samples and assayed by Luminex Multiplex for 24 different HPV types, including 15 high-risk (HR), three putative HR and six low-risk types (LR). RESULTS We successfully analysed 154/215 (71.6%) of the locally diagnosed cases and found a high prevalence of HPV with 92.9% in all uterine cervix cancer cases, and 93.3% and 91.4 % in SCC and ADC, respectively. All HPV positive cases harboured HR types, either alone or as multiple infections. In SCC HPV16 dominated and together with HPV18 accounted for 69.7% of the cases, followed in prevalence by HPV33, 31 and 45. In ADC, HPV18 was more common than HPV16, and they were observed in all except one of the HPV positive samples. CONCLUSION The prevalence of HPV16 and 18, followed by HPV33, 31 and 45 is high in SCC and ADC in the Stockholm region. Public HPV vaccination could potentially inhibit a large proportion of such tumours underlining the urgency to initiate HPV vaccination.
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Affiliation(s)
- Juan Du
- Department of Oncology-Pathology Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.
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Rubin J, Giraud G, Priftakis P, Wide K, Gustafsson B, Ramqvist T, Dalianis T. No detection of BK virus, JC virus, KI, WU and Merkel cell polyomaviruses in cerebrospinal fluid of patients with neurological complications after hematopoetic stem cell transplantation. Anticancer Res 2011; 31:3489-3492. [PMID: 21965766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Neurological complications, often due to viral reactivation, after allogeneic hematopoetic stem cell transplantation (HSCT) are associated with increased mortality. Here, cerebrospinal fluid from 20 HSCT patients with neurological symptoms were analyzed and found to be negative by PCR for BK virus, JC virus, KI, WU and Merkel cell polyomavirus DNA.
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Affiliation(s)
- J Rubin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital Huddinge, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, Stockholm, Sweden
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Eriksson M, Andreasson K, Weidmann J, Lundberg K, Tegerstedt K, Dalianis T, Ramqvist T. Murine polyomavirus virus-like particles carrying full-length human PSA protect BALB/c mice from outgrowth of a PSA expressing tumor. PLoS One 2011; 6:e23828. [PMID: 21858228 PMCID: PMC3157473 DOI: 10.1371/journal.pone.0023828] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 07/26/2011] [Indexed: 11/18/2022] Open
Abstract
Virus-like particles (VLPs) consist of capsid proteins from viruses and have been shown to be usable as carriers of protein and peptide antigens for immune therapy. In this study, we have produced and assayed murine polyomavirus (MPyV) VLPs carrying the entire human Prostate Specific Antigen (PSA) (PSA-MPyVLPs) for their potential use for immune therapy in a mouse model system. BALB/c mice immunized with PSA-MPyVLPs were only marginally protected against outgrowth of a PSA-expressing tumor. To improve protection, PSA-MPyVLPs were co-injected with adjuvant CpG, either alone or loaded onto murine dendritic cells (DCs). Immunization with PSA-MPyVLPs loaded onto DCs in the presence of CpG was shown to efficiently protect mice from tumor outgrowth. In addition, cellular and humoral immune responses after immunization were examined. PSA-specific CD4+ and CD8+ cells were demonstrated, but no PSA-specific IgG antibodies. Vaccination with DCs loaded with PSA-MPyVLPs induced an eight-fold lower titre of anti-VLP antibodies than vaccination with PSA-MPyVLPs alone. In conclusion, immunization of BALB/c mice with PSA-MPyVLPs, loaded onto DCs and co-injected with CpG, induces an efficient PSA-specific tumor protective immune response, including both CD4+ and CD8+ cells with a low induction of anti-VLP antibodies.
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Affiliation(s)
- Mathilda Eriksson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
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Ramqvist T, Dalianis T. An epidemic of oropharyngeal squamous cell carcinoma (OSCC) due to human papillomavirus (HPV) infection and aspects of treatment and prevention. Anticancer Res 2011; 31:1515-1519. [PMID: 21617204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In Europe and the US the incidence of oropharyngeal squamous cell carcinoma (OSCC), where tonsillar and tongue base cancer dominate, has increased and we propose this is due to an epidemic of human papillomavirus (HPV) infection. We base our hypothesis on two main findings. Firstly, in the past decade numerous reports have shown the presence of HPV in OSCC, and that HPV-positive OSCC has a significantly better response to therapy than HPV-negative OSCC. As a consequence of these findings, the International Agency for Research against Cancer (IARC) has acknowledged HPV, in addition to smoking and alcohol, as a risk factor for OSCC. Secondly, we and others have demonstrated a considerable and significant increase in the proportion of HPV-positive tonsillar and tongue base cancer/OSCC in recent decades. In conclusion, we suggest that the increased incidence of OSCC is due to an HPV epidemic. In addition, since patients with HPV-positive OSCC have a better response to therapy than those with HPV-negative OSCC, we put forward that it is important to individualize therapy on the basis of HPV status and other markers in order to obtain optimal survival with the least side-effects. Finally, we suggest that the possibility to vaccinate against HPV-positive OSCC should be examined.
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Affiliation(s)
- Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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Abstract
Patients with HPV-positive cancer were young and lacked traditional risk factors. Oropharyngeal Cancer Epidemic and HPV A growing body of research shows that human papillomavirus (HPV) is a common and increasing cause of oropharyngeal squamous cell carcinoma (OSCC). Thus, the International Agency for Research against Cancer has acknowledged HPV as a risk factor for OSCC, in addition to smoking and alcohol consumption. Recently, in Finland, the United Kingdom, the Netherlands, the United States, and Sweden, incidence of OSCC has increased, and an increase in the proportion of HPV-positive tumors was noted. On the basis of these data and reports indicating that patients with HPV-positive cancer have their first sexual experience at a young age and have multiple partners, we postulate that increased incidence of OSCC in the United States and some countries in northern Europe is because of a new, primarily sexually transmitted HPV epidemic. We also suggest that individualized treatment modalities and preventive vaccination should be further explored.
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Dalianis T, Ljungman P. Full myeloablative conditioning and an unrelated HLA mismatched donor increase the risk for BK virus-positive hemorrhagic cystitis in allogeneic hematopoetic stem cell transplanted patients. Anticancer Res 2011; 31:939-944. [PMID: 21498717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BK virus (BKV)-associated hemorrhagic cystitis (HC), varying from mild hematuria with or without dysuria to life-threating bleeding and clots that may cause urinary obstruction and renal failure, causes significant morbidity and mortality in haematopoetic stem cell transplanted (HSCT) patients. Unfortunately, its development is difficult to predict since BK viruria is very common after HSCT and can be present in patients with and without HC. There is therefore the need to identify risk factors that may increase the risk of developing HC after HSCT. The viral load of BK-viruria, as well as BK viremia, has been monitored for this purpose. Moreover, having full myeoblative conditioning (MC) versus reduced intensity conditioning (RIC) prior to HSCT and an HLA-matched or -mismatched graft from an unrelated donor in contrast to an HLA-matched graft from a related donor have been studied as risk factors for HC. In addition, graft versus host disease has been examined, but has not been defined as a definite risk factor for HC. We conclude that the present evidence suggests that HSCT patients with BK viruria, receiving MC and an unrelated donor graft that is HLA-mismatched have an increased risk for developing HC in comparison to patients receiving RIC and an HLA-matched related donor graft.
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Affiliation(s)
- Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska R8:01, Karolinska Hospital, 171 76 Stockholm, Sweden.
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Ramqvist T, Du J, Lundén M, Ahrlund-Richter S, Ferreira J, Marions L, Sparén P, Andersson S, Dalianis T. Pre-vaccination prevalence of human papillomavirus types in the genital tract of 15-23-year-old women attending a youth health clinic in Stockholm, Sweden. ACTA ACUST UNITED AC 2010; 43:115-21. [PMID: 20964488 DOI: 10.3109/00365548.2010.526957] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Knowledge of the prevalence of different human papillomavirus (HPV) types in young girls is important for the early detection of changes in HPV prevalence, e.g. due to HPV vaccines. The purpose of this study was to obtain information on the prevalence of 24 different genital HPV types in a group of sexually active young women (aged 15-23 y) attending a major youth healthcare centre in Stockholm, before the introduction of public HPV vaccination of young women in the autumn of 2010. A total of 615 women were analyzed for 24 different, mainly high-risk HPV (HR-HPV) types using multiplex polymerase chain reaction and Luminex technology. A high HPV prevalence in this cohort was demonstrated, particularly with regard to HPV16, but also to all included HR-HPV types. Of the 544 successfully analyzed samples from non-vaccinated individuals, 70% were positive for the HPV types assayed for, and 62% were positive for HR-HPV types. Over a third (34.7%) of the women were infected with HPV16, and a high frequency of infections with HR-HPV types 51 (10.7%), 18 (10.1%), 52 (9.9%) and 73 (9.4%) was also observed. At least 9 different non-vaccine HR-HPV types were present with a prevalence of >6% in this selected group of young women.
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Affiliation(s)
- Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
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