1
|
Monti E, Somigliana E, Alberico D, Boero V, Iorio M, Di Loreto E, Dell'acqua A, Liverani CA. Conservative Treatment for Cervical Adenocarcinoma In Situ: Long-Term Results. J Low Genit Tract Dis 2022; 26:293-297. [PMID: 35917498 DOI: 10.1097/lgt.0000000000000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of conservative treatment for cervical adenocarcinoma in situ (AIS). MATERIALS AND METHODS This is a retrospective study on women with histologically confirmed AIS on cervical loop electrosurgical excision procedure specimen, treated conservatively between 2008 and 2020 in our center, Ospedale Maggiore Policlinico, Milan. The main outcome investigated was the risk of recurrence defined as a subsequent finding of recurrent AIS or invasive adenocarcinoma in a long-term follow-up. The disease-free survival curve was computed using the Kaplan-Meyer method. All patients underwent colposcopy with endocervical curettage and cytology every 6 months for the first 2 years after initial surgery and then annual cytology. RESULTS Thirty women, aged 26 to 51 years, with histologically proven AIS on excisional specimen with negative margins, negative apex, and negative endocervical curettage were included. The median follow-up was 5.4 years. One woman had a recurrence of AIS after 8 years of follow-up and underwent total hysterectomy. No invasive cervical disease was detected during surveillance. CONCLUSIONS Women with cervical AIS can be managed conservatively by an excisional procedure, provided that the margins are free and a close and long-term follow-up is guaranteed.
Collapse
Affiliation(s)
- Ermelinda Monti
- Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Daniela Alberico
- Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronica Boero
- Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Iorio
- Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Eugenia Di Loreto
- Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Dell'acqua
- Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | | |
Collapse
|
2
|
Cleveland AA, Gargano JW, Park IU, Griffin MR, Niccolai LM, Powell M, Bennett NM, Saadeh K, Pemmaraju M, Higgins K, Ehlers S, Scahill M, Jones MLJ, Querec T, Markowitz LE, Unger ER. Cervical adenocarcinoma in situ: Human papillomavirus types and incidence trends in five states, 2008-2015. Int J Cancer 2020; 146:810-818. [PMID: 30980692 PMCID: PMC9112013 DOI: 10.1002/ijc.32340] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/19/2019] [Accepted: 04/01/2019] [Indexed: 08/05/2023]
Abstract
Primary prevention through the use of human papillomavirus (HPV) vaccination is expected to impact both cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS). While CIN is well described, less is known about the epidemiology of AIS, a rare cervical precancer. We identified AIS and CIN grade 3 (CIN3) cases through population-based surveillance, and analyzed data on HPV types and incidence trends overall, and among women screened for cervical cancer. From 2008 to 2015, 470 AIS and 6,587 CIN3 cases were identified. The median age of women with AIS was older than those with CIN3 (35 vs. 31 years; p < 0.01). HPV16 was the most frequently detected type in both AIS and CIN3 (57% in AIS; 58% in CIN3), whereas HPV18 was the second most common type in AIS and less common in CIN3 (38% vs. 5%; p < 0.01). AIS lesions were more likely than CIN3 lesions to be positive for high-risk types targeted by the bivalent and quadrivalent vaccines (HPV16/18, 92% vs. 63%; p < 0.01), and 9-valent vaccine (HPV16/18/31/33/45/52/58, 95% vs. 87%; p < 0.01). AIS incidence rates decreased significantly in the 21-24 year age group (annual percent change [APC] overall: -22.1%, 95% CI: -33.9 to -8.2; APC among screened: -16.1%, 95% CI: -28.8 to -1.2), but did not decrease significantly in any older age group. This report on the largest number of genotyped AIS cases to date suggests an important opportunity for vaccine prevention of AIS, and is the first to document a decline in AIS incidence rates among young women during the vaccine era.
Collapse
Affiliation(s)
| | | | - Ina U. Park
- Department of Family and Community Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | | | - Nancy M. Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Kayla Saadeh
- California Emerging Infections Program, Oakland, CA, USA
| | | | - Kyle Higgins
- Yale School of Public Health, New Haven, CT, USA
| | - Sara Ehlers
- Oregon Department of Human Services, Portland, OR, USA
| | - Mary Scahill
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | - Troy Querec
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | |
Collapse
|
3
|
Costa TML, Heráclio S, Amorim MMR, Souza PRE, Lubambo N, Souza GFDA, Souza ASR. Human papillomavirus and risk factors for cervical adenocarcinoma in the state of Pernambuco, Brazil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2019. [DOI: 10.1590/1806-93042019000300009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to determine the incidence of the main high oncogenic risk types of the human papillomavirus (HPV) ( 16, 18, 31 and 33) and the risk factors for cervical adenocarcinoma. Methods: a case-control study was carried out with 324 women (69 with adenocarcinoma and 260 healthy controls) between 2001 and 2014. Information on risk factors associated with adenocarcinomawere collected and the detection performed on HPVby using Polymerase Chain Reaction (PCR) method. Results: adenocarcinoma was associated with age ≥40 years old (OR=2.95; 95%CI=1.13-7.71), ≤3 years of schooling (OR=2.34; 95%CI=1.02-5.37), presence of HPV (OR=6.75; 95%CI=2.41-18.91),women in menopausal status (OR=4.76; 95%CI:1.70-13.31) black race (OR=6.71; 95%CI= 2.11-21.32) and never had undergone cervical cancer screening (OR=9.92; 95%CI:2.41-40.81). Andamong the HPV types detected, HPV 18 was observed to be strongly associated with adenocarcinoma of the cervix (OR=99.1; 95%CI=12.96-757.78). Conclusions: the factors associated with cervical adenocarcinoma were ≥40 years old, ≤3 years of schooling, black race, menopausal status, never had undergone cervical cancer screening and the presence of HPV.
Collapse
Affiliation(s)
| | - Sandra Heráclio
- Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
| | | | | | | | | | | |
Collapse
|
4
|
Srisomboon S, Tantipalakorn C, Charoenkwan K, Srisomboon J. Cervical Screening Results Leading to Detection of Adenocarcinoma in Situ of the Uterine Cervix. Asian Pac J Cancer Prev 2019; 20:377-382. [PMID: 30803195 PMCID: PMC6897002 DOI: 10.31557/apjcp.2019.20.2.377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/18/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Adenocarcinoma in situ (AIS) of the uterine cervix is a preinvasive lesion of the invasive adenocarcinoma. We analyzed the cervical screening results leading to detecting the AIS lesions including the coexistence of AIS lesions with high-grade squamous intra-epithelial lesions (HSIL) and invasive carcinoma. Methods: Women who were diagnosed and received treatment for AIS at Chiang Mai University Hospital between January 1, 2007 and August 31, 2016 were retrospectively reviewed. The inclusion criteria were the women who had pathological diagnosis of AIS obtained from cervical punch biopsy or excisional cone biopsy with either loop electrosurgical excision procedure (LEEP) or cold-knife conization (CKC). The patient characteristics, diagnostic work-up and treatment details were reviewed, including the cervical screening results prior to the diagnosis of cervical AIS, pathologic results of excisional cone biopsy and hysterectomy specimens. Results: During the study period, 75 women with AIS pathology undergoing excisional cone biopsy with either LEEP (n=62) or CKC (n=13) were identified. The abnormal cytologic screening leading to detection of AIS was the squamous cell abnormality accounting for 57.3%. Abnormal glandular cytology accounted for 37.3%. The most common abnormal cervical screening results was HSIL cytology (n = 25) followed by AIS cytology (n = 13). Normal cytology was noted in 4 women in whom 3 were positive for HPV 18 and 1 had AIS on the endocervical polyp. AIS coexisted with HSIL and invasive carcinoma were detected in cone biopsy specimens in 21 (28%) and 29 (38.7%) patients, respectively. Conclusion: The majority of cervical screening results leading to detection of cervical AIS was the squamous cell abnormality accounting for 57.3% in which, HSIL cytology was the most common. Abnormal glandular cytology accounted for only 37.3%. Diagnostic cone excision is recommended if AIS lesion is noted in cervical biopsy specimen since nearly 40% have coexisting invasive lesions.
Collapse
Affiliation(s)
- Santipap Srisomboon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang aMai, Thailand.
| | | | | | | |
Collapse
|
5
|
Jiang W, Marshall Austin R, Li L, Yang K, Zhao C. Extended Human Papillomavirus Genotype Distribution and Cervical Cytology Results in a Large Cohort of Chinese Women With Invasive Cervical Cancers and High-Grade Squamous Intraepithelial Lesions. Am J Clin Pathol 2018; 150:43-50. [PMID: 29746625 DOI: 10.1093/ajcp/aqy022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To study the human papillomavirus (HPV) genotype distribution of cervical cancer (CxCa) and cervical intraepithelial neoplasia grade 2/3 (CIN2/3) in China and to evaluate cotesting of HPV and cytology in CxCa screening. METHODS Patients with histopathologic CxCa and CIN 2/3 diagnoses reported between January 2012 and June 2016 and extended HPV genotype testing in the prior 6 months were documented in the institute. Available prior Papanicolaou (Pap) test results were also documented. Extended HPV genotype testing was performed using two China Food and Drug Administration-approved HPV tests. RESULTS CxCa and CIN 2/3 diagnoses and recent prior HPV test results were documented in 370 CxCa cases and 2774 CIN 2/3 cases. The high-risk (hr) HPV-positive rate was 88.4% for CxCa and 90.1% for CIN 2/3. Among 327 HPV-positive CxCa cases, the most common HPV types were HPV 16 (70.3%), 18 (7.0%), 58 (5.7%), 33 (4.1%), and 53 and 59 (1.9% each). Among 2499 hrHPV-positive CIN 2/3 cases, the most common HPV types were HPV 16 (53.3%), 58 (21.4%), 52 (11%), 33 (10.6%), and 18 (5.1%). 161 CxCa cases and 1094 CIN 2/3 cases also had available prior cotest results. Among cotested cases hrHPV-negative results were reported in 12.4% of CxCa and 10.1% of CIN 2/3 cases compared to cytology-negative results reported in 15.5% of CxCa and 4.3% of CIN 2/3. CONCLUSIONS HPV 16/18/59/39/45 genotypes were significantly more prevalent in CxCa cases than in CIN 2/3 cases, consistent with the more limited progressive potential of some CIN 2/3 lesions. Of CIN 2/3 and CxCa cases, 10% to 12% had recent negative hrHPV test results, pointing to a significant limitation of primary HPV screening.
Collapse
Affiliation(s)
- Wei Jiang
- Department of Pathology, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - R Marshall Austin
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Lei Li
- Department of Pathology, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Kaixuan Yang
- Department of Pathology, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Chengquan Zhao
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
6
|
Mirabello L, Clarke MA, Nelson CW, Dean M, Wentzensen N, Yeager M, Cullen M, Boland JF, Schiffman M, Burk RD. The Intersection of HPV Epidemiology, Genomics and Mechanistic Studies of HPV-Mediated Carcinogenesis. Viruses 2018; 10:v10020080. [PMID: 29438321 PMCID: PMC5850387 DOI: 10.3390/v10020080] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/24/2018] [Accepted: 02/12/2018] [Indexed: 12/14/2022] Open
Abstract
Of the ~60 human papillomavirus (HPV) genotypes that infect the cervicovaginal epithelium, only 12–13 “high-risk” types are well-established as causing cervical cancer, with HPV16 accounting for over half of all cases worldwide. While HPV16 is the most important carcinogenic type, variants of HPV16 can differ in their carcinogenicity by 10-fold or more in epidemiologic studies. Strong genotype-phenotype associations embedded in the small 8-kb HPV16 genome motivate molecular studies to understand the underlying molecular mechanisms. Understanding the mechanisms of HPV genomic findings is complicated by the linkage of HPV genome variants. A panel of experts in various disciplines gathered on 21 November 2016 to discuss the interdisciplinary science of HPV oncogenesis. Here, we summarize the discussion of the complexity of the viral–host interaction and highlight important next steps for selected applied basic laboratory studies guided by epidemiological genomic findings.
Collapse
Affiliation(s)
- Lisa Mirabello
- Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA; (M.A.C.); (C.W.N.); (M.D.); (N.W.); (M.Y.); (M.C.); (J.F.B.); (M.S.)
- Correspondence: (L.M.); (R.D.B.)
| | - Megan A. Clarke
- Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA; (M.A.C.); (C.W.N.); (M.D.); (N.W.); (M.Y.); (M.C.); (J.F.B.); (M.S.)
| | - Chase W. Nelson
- Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA; (M.A.C.); (C.W.N.); (M.D.); (N.W.); (M.Y.); (M.C.); (J.F.B.); (M.S.)
- Sackler Institute for Comparative Genomics, American Museum of Natural History, New York, NY 10024, USA
| | - Michael Dean
- Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA; (M.A.C.); (C.W.N.); (M.D.); (N.W.); (M.Y.); (M.C.); (J.F.B.); (M.S.)
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA; (M.A.C.); (C.W.N.); (M.D.); (N.W.); (M.Y.); (M.C.); (J.F.B.); (M.S.)
| | - Meredith Yeager
- Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA; (M.A.C.); (C.W.N.); (M.D.); (N.W.); (M.Y.); (M.C.); (J.F.B.); (M.S.)
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick, MD 21701, USA
| | - Michael Cullen
- Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA; (M.A.C.); (C.W.N.); (M.D.); (N.W.); (M.Y.); (M.C.); (J.F.B.); (M.S.)
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick, MD 21701, USA
| | - Joseph F. Boland
- Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA; (M.A.C.); (C.W.N.); (M.D.); (N.W.); (M.Y.); (M.C.); (J.F.B.); (M.S.)
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick, MD 21701, USA
| | | | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA; (M.A.C.); (C.W.N.); (M.D.); (N.W.); (M.Y.); (M.C.); (J.F.B.); (M.S.)
| | - Robert D. Burk
- Departments of Pediatrics, Microbiology and Immunology, Epidemiology and Population Health, and Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Correspondence: (L.M.); (R.D.B.)
| |
Collapse
|
7
|
Prevalence of human papillomavirus genotypes and relative risk of cervical cancer in China: a systematic review and meta-analysis. Oncotarget 2018; 9:15386-15397. [PMID: 29632652 PMCID: PMC5880612 DOI: 10.18632/oncotarget.24169] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 12/06/2017] [Indexed: 11/25/2022] Open
Abstract
High-risk HPV (hrHPV) is related to cervical carcinogenesis, although clinical data comparing the natural history and carcinogenic potential of type-specific HPV remain limited. Furthermore, the nationwide prevalence rates of overall and type-specific HPV among women with cervical precancerous lesions and cancer have not been reported. Here, a meta-analysis was performed for type-specific HPV distribution among 30,165 HPV-positive women, including 12,094 invasive cervical cancers (ICCs), 10,026 cervical intraepithelial neoplasia grade 2/3 (CIN2/3), 3246 CIN1, and 4799 normal cervices from 45 PCR-based studies. We found that HPV16 was the most common hrHPV type involved in cervical disease. The HPV16 positivity rate varied little across normal (22.7%) and CIN1 individuals (23.6%) but increased through the CIN2 (37.6%) and CIN3 patients (51.9%) to 65.6% in ICC cases. HPV16, 18, 35, 39, 45, and 59 were more frequent in ICC than CIN3, with ICC:CIN3 ratios ranging from 2.3 for HPV18 to 1.1 for HPV35/45. HPV31, 33, 52, and 58 were more frequent in CIN3 compared with normal cervices but less common in ICC compared with CIN3 (ICC:CIN3 ratios ranging from 0.6 for HPV58 and 0.4 for HPV52). The ICC:normal ratios were particularly high for HPV18, 52 and 58 in West China (4.1, 3.9 and 2.9, respectively) and for HPV45 and 59 in North China (1.6 and 1.1, respectively). In summary, this study is the most comprehensive analysis of type-specific HPV distribution in cervical carcinogenesis and could be valuable for HPV-based cervical cancer screening strategies and vaccination policies in China.
Collapse
|
8
|
Huh WK, Joura EA, Giuliano AR, Iversen OE, de Andrade RP, Ault KA, Bartholomew D, Cestero RM, Fedrizzi EN, Hirschberg AL, Mayrand MH, Ruiz-Sternberg AM, Stapleton JT, Wiley DJ, Ferenczy A, Kurman R, Ronnett BM, Stoler MH, Cuzick J, Garland SM, Kjaer SK, Bautista OM, Haupt R, Moeller E, Ritter M, Roberts CC, Shields C, Luxembourg A. Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16-26 years: a randomised, double-blind trial. Lancet 2017; 390:2143-2159. [PMID: 28886907 DOI: 10.1016/s0140-6736(17)31821-4] [Citation(s) in RCA: 255] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/08/2017] [Accepted: 06/15/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Primary analyses of a study in young women aged 16-26 years showed efficacy of the nine-valent human papillomavirus (9vHPV; HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58) vaccine against infections and disease related to HPV 31, 33, 45, 52, and 58, and non-inferior HPV 6, 11, 16, and 18 antibody responses when compared with quadrivalent HPV (qHPV; HPV 6, 11, 16, and 18) vaccine. We aimed to report efficacy of the 9vHPV vaccine for up to 6 years following first administration and antibody responses over 5 years. METHODS We undertook this randomised, double-blind, efficacy, immunogenicity, and safety study of the 9vHPV vaccine study at 105 study sites in 18 countries. Women aged 16-26 years old who were healthy, with no history of abnormal cervical cytology, no previous abnormal cervical biopsy results, and no more than four lifetime sexual partners were randomly assigned (1:1) by central randomisation and block sizes of 2 and 2 to receive three intramuscular injections over 6 months of 9vHPV or qHPV (control) vaccine. All participants, study investigators, and study site personnel, laboratory staff, members of the sponsor's study team, and members of the adjudication pathology panel were masked to vaccination groups. The primary outcomes were incidence of high-grade cervical disease (cervical intraepithelial neoplasia grade 2 or 3, adenocarcinoma in situ, invasive cervical carcinoma), vulvar disease (vulvar intraepithelial neoplasia grade 2/3, vulvar cancer), and vaginal disease (vaginal intraepithelial neoplasia grade 2/3, vaginal cancer) related to HPV 31, 33, 45, 52, and 58 and non-inferiority (excluding a decrease of 1·5 times) of anti-HPV 6, 11, 16, and 18 geometric mean titres (GMT). Tissue samples were adjudicated for histopathology diagnosis and tested for HPV DNA. Serum antibody responses were assessed by competitive Luminex immunoassay. The primary evaluation of efficacy was a superiority analysis in the per-protocol efficacy population, supportive efficacy was analysed in the modified intention-to-treat population, and the primary evaluation of immunogenicity was a non-inferiority analysis. The trial is registered with ClinicalTrials.gov, number NCT00543543. FINDINGS Between Sept 26, 2007, and Dec 18, 2009, we recruited and randomly assigned 14 215 participants to receive 9vHPV (n=7106) or qHPV (n=7109) vaccine. In the per-protocol population, the incidence of high-grade cervical, vulvar and vaginal disease related to HPV 31, 33, 45, 52, and 58 was 0·5 cases per 10 000 person-years in the 9vHPV and 19·0 cases per 10 000 person-years in the qHPV groups, representing 97·4% efficacy (95% CI 85·0-99·9). HPV 6, 11, 16, and 18 GMTs were non-inferior in the 9vHPV versus qHPV group from month 1 to 3 years after vaccination. No clinically meaningful differences in serious adverse events were noted between the study groups. 11 participants died during the study follow-up period (six in the 9vHPV vaccine group and five in the qHPV vaccine group); none of the deaths were considered vaccine-related. INTERPRETATION The 9vHPV vaccine prevents infection, cytological abnormalities, high-grade lesions, and cervical procedures related to HPV 31, 33, 45, 52, and 58. Both the 9vHPV vaccine and qHPV vaccine had a similar immunogenicity profile with respect to HPV 6, 11, 16, and 18. Vaccine efficacy was sustained for up to 6 years. The 9vHPV vaccine could potentially provide broader coverage and prevent 90% of cervical cancer cases worldwide. FUNDING Merck & Co, Inc.
Collapse
MESH Headings
- Adolescent
- Adult
- Antibodies, Viral/blood
- Dose-Response Relationship, Drug
- Double-Blind Method
- Female
- Follow-Up Studies
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18/administration & dosage
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18/immunology
- Human papillomavirus 6/immunology
- Humans
- Immunoassay
- Immunogenicity, Vaccine/immunology
- Injections, Intramuscular
- Papillomavirus Infections/epidemiology
- Papillomavirus Infections/prevention & control
- Patient Compliance/statistics & numerical data
- Patient Safety
- Primary Prevention/methods
- Treatment Outcome
- Uterine Cervical Neoplasms/epidemiology
- Uterine Cervical Neoplasms/prevention & control
- Uterine Cervical Neoplasms/virology
- Vaccination/methods
- Young Adult
Collapse
Affiliation(s)
- Warner K Huh
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Elmar A Joura
- Department of Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Anna R Giuliano
- Center for Infection Research in Cancer, Moffitt Cancer Centre, Tampa, FL, USA
| | - Ole-Erik Iversen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Rosires Pereira de Andrade
- CERHFAC/Universidade Federal do Paraná, Setor de Ciências da Saúde, Departamento de Tocoginecologia, Paraná, Brazil
| | - Kevin A Ault
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Deborah Bartholomew
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ramon M Cestero
- Department of Obstetrics and Gynecology, University of California Irvine School of Medicine, UC Irvine Health Orange, CA, USA
| | - Edison N Fedrizzi
- Department of Obstetrics and Gynecology of The Federal University of Santa Catarina, Santa Catarina, Brazil
| | - Angelica L Hirschberg
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Stockholm, Sweden
| | - Marie-Hélène Mayrand
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal [CRCHUM], Montreal, QC, Canada
| | | | - Jack T Stapleton
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA; Iowa City VA Medical Center, Iowa City, IA, USA
| | - Dorothy J Wiley
- School of Nursing, University of California, Los Angeles, CA, USA
| | - Alex Ferenczy
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Robert Kurman
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Brigitte M Ronnett
- Department of Pathology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - Mark H Stoler
- Department of Pathology, University of Virginia School of Medicine Charlottesville, VA, USA
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Suzanne M Garland
- The University of Melbourne, Department of Obstetrics and Gynaecology, The Royal Women's Hospital, University of Melbourne, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society and Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Clifford GM, Tully S, Franceschi S. Carcinogenicity of Human Papillomavirus (HPV) Types in HIV-Positive Women: A Meta-Analysis From HPV Infection to Cervical Cancer. Clin Infect Dis 2017; 64:1228-1235. [PMID: 28199532 PMCID: PMC5399941 DOI: 10.1093/cid/cix135] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/10/2017] [Indexed: 12/14/2022] Open
Abstract
Background Data on the relative carcinogenic potential of human papillomavirus (HPV) types among women infected with human immunodeficiency virus (HIV) (WHIV) are needed to inform prevention programs for this population. Methods A systematic literature review and meta-analysis of high-risk HPV-type distribution in 19883 HIV-positive women was performed. The women, from 86 studies worldwide, included 11739 with normal cytological findings; 1784 with atypical squamous cells of undetermined significance (ASCUS); 2173 with low-grade and 1282 with high-grade squamous intraepithelial lesions (HSILs) diagnosed cytologically; 1198 with cervical intraepithelial neoplasia grade 1 (CIN1), 456 with CIN2, and 455 with CIN3 diagnosed histologically; and 796 with invasive cervical cancers (ICCs). A large proportion of WHIV, and almost all with ICCs, were from Africa. Results In Africa, HPV 16 accounted for 13% of HPV-positive WHIV with normal cytological findings, but this proportion increased through ASCUS, low-grade squamous intraepithelial lesions, CIN1, and CIN2 (18%-25%), up to 41%-47% for CIN3 and ICCs. Only HPV 16, HPV 18, and HPV 45 accounted for a greater proportion of HPV infections in ICCs compared with normal cytological findings (ICC:normal ratios, 3.68, 2.47, and 2.55, respectively). Other high-risk types accounted for important proportions of low- and/or high-grade lesions, but their contribution dropped in ICCs, with ICC:normal ratios in Africa ranging from 0.79 for HPV 33 down to 0.38 for HPV 56. Findings for HPV 16 and HPV 18 in Europe/North America, Asia, and Latin America were compatible with those from Africa. Conclusions HPV 16 and HPV 18 in particular, but also HPV 45, at least in Africa, warrant special attention in WHIV. Broad consistency of findings with those in HIV-uninfected population would suggest that the risk stratification offered by partial HPV genotyping tests also have relevance for HIV-positive women.
Collapse
Affiliation(s)
| | - Stephen Tully
- International Agency for Research on Cancer, Lyon, France
| | | |
Collapse
|
10
|
Kim J, Bell C, Sun M, Kliewer G, Xu L, McInerney M, Svenson LW, Yang H. Effect of human papillomavirus vaccination on cervical cancer screening in Alberta. CMAJ 2016; 188:E281-E288. [PMID: 27378467 PMCID: PMC5008954 DOI: 10.1503/cmaj.151528] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 03/22/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A school-based program with quadrivalent human papillomavirus (HPV) vaccination was implemented in Alberta in 2008. We assessed the impact of this program on Pap test cytology results using databases of province-wide vaccination and cervical cancer screening. METHODS We conducted a nested case-control study involving a cohort of women in Alberta born between 1994 and 1997 who had at least 1 Pap test between 2012 and 2015. Women with negative cytology results were controls. Women with low-grade (atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion) and high-grade (atypical squamous cells, cannot rule out a high-grade lesion; or high-grade squamous intraepithelial lesion) cervical abnormalities were cases. Exposure status was assigned according to records of HPV vaccination. Odds ratios (ORs) for abnormal cytology results by vaccination status were adjusted for neighbourhood income, laboratory service, rural versus urban residency, and age. RESULTS The total study population was 10 204. Adjusting for age, vaccinated women had a higher screening rate than unvaccinated women (13.0% v. 11.4%, p < 0.001). Among women who received full vaccination (≥ 3 doses), the adjusted OR for cervical abnormalities was 0.72 (95% confidence interval [CI] 0.63-0.82). For high-grade lesions, the adjusted OR was 0.50 (95% CI 0.30-0.85). With 2-dose HPV vaccination, the adjusted OR for cervical abnormalities was 1.08 (95% CI 0.84-1.38). INTERPRETATION Quadrivalent HPV vaccination significantly reduced high-grade cervical abnormalities but required 3 doses. Vaccination against HPV was associated with screening uptake. Population-based vaccination and screening programs should work together to optimize cervical cancer prevention.
Collapse
Affiliation(s)
- Jong Kim
- Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta
| | - Christopher Bell
- Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta
| | - Maggie Sun
- Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta
| | - Gordon Kliewer
- Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta
| | - Linan Xu
- Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta
| | - Maria McInerney
- Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta
| | - Lawrence W Svenson
- Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta
| | - Huiming Yang
- Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta.
| |
Collapse
|
11
|
Nowakowski A, Cybulski M, Buda I, Janosz I, Olszak-Wąsik K, Bodzek P, Śliwczyński A, Teter Z, Olejek A, Baranowski W. Cervical Cancer Histology, Staging and Survival before and after Implementation of Organised Cervical Screening Programme in Poland. PLoS One 2016; 11:e0155849. [PMID: 27196050 PMCID: PMC4873170 DOI: 10.1371/journal.pone.0155849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/05/2016] [Indexed: 11/18/2022] Open
Abstract
A population-based organised cervical cancer screening programme (OCCSP) was introduced in Poland in 2006. In this study we have aimed to analyse whether selected parameters related to invasive cervical cancer (ICC) of patients diagnosed in two distant gynaecological oncology centres changed after the first screening round of the programme run between 2006-2008. We have run a retrospective cross-sectional analysis of 189 women diagnosed with ICC between 2002-2005 (directly before introduction of the programme) and 165 patients diagnosed between 2009-2012 (just after the first screening round of the programme) and compared their age at diagnosis, histology, stage of tumours and overall survival (OS). Mean age of patients diagnosed in years 2002-2005 and 2009-2012 was 52.1 and 52.6 years respectively. Squamous cell carcinomas constituted 90.5% and 86.1% of tumours diagnosed in years 2002-2005 and 2009-2012 respectively and the rest of tumours had glandular and other histologies. 74.5% and 61.0% of women diagnosed in years 2002-2005 and 2009-2012 respectively had early ICC (FIGO-International Federation of Gynaecology and Obstetrics stages I-IIA) and the rest had advanced disease (FIGO IIB-IV). We have noticed no significant differences in mean age of patients, histology of tumours and OS of patients with ICC diagnosed before and after the first screening round of OCSSP in Poland. Advanced stages of ICC were more commonly diagnosed after the introduction of OCSSP. Changes only in some clinical parameters of patients with ICC were noticed before and after the first screening round of OCSSP in Poland but OS of patients remained the same.
Collapse
Affiliation(s)
- Andrzej Nowakowski
- Department of Gynaecology and Oncological Gynaecology, Military Institute of Medicine, Warsaw, Poland
| | - Marek Cybulski
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, Lublin, Poland
| | - Irmina Buda
- Department of Gynaecology and Oncological Gynaecology, Military Institute of Medicine, Warsaw, Poland
| | - Iwona Janosz
- Department of Obstetrics, Gynaecology and Oncological Gynaecology, Medical University of Silesia, Bytom, Poland
| | - Katarzyna Olszak-Wąsik
- Department of Obstetrics, Gynaecology and Oncological Gynaecology, Medical University of Silesia, Bytom, Poland
| | - Piotr Bodzek
- Department of Obstetrics, Gynaecology and Oncological Gynaecology, Medical University of Silesia, Bytom, Poland
| | | | | | - Anita Olejek
- Department of Obstetrics, Gynaecology and Oncological Gynaecology, Medical University of Silesia, Bytom, Poland
| | - Włodzimierz Baranowski
- Department of Gynaecology and Oncological Gynaecology, Military Institute of Medicine, Warsaw, Poland
| |
Collapse
|
12
|
Bava SV, Thulasidasan AKT, Sreekanth CN, Anto RJ. Cervical cancer: A comprehensive approach towards extermination. Ann Med 2016; 48:149-61. [PMID: 26911282 DOI: 10.3109/07853890.2016.1145796] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Human Papilloma Virus (HPV) is one of the most common sexually transmitted pathogen, globally. Oncogenic types of HPV are the causative agents of many neoplastic diseases, including cervical cancer, which ranks as the most common cancer affecting females in developing countries. HPV infection of the cervical epithelium and the subsequent integration of viral DNA into the host genome are the major risk factors for cervical cancer. The scientific discovery of HPV as the causal agent of cervical cancer has led to the development of HPV-based diagnostic tools. Prophylactic vaccines, based on the oncogenic HPV type virus-like particles have been introduced in several developed countries as a preliminary preventive approach. Nevertheless, it remains a continuous threat to women in developing countries, where the prophylactic vaccines are unaffordable and organized screening programmes are lacking. This warrants implementation of prevention strategies that will reduce cervical cancer-related mortality. In this review, we have discussed molecular pathogenesis of HPV infection and the risk factors associated with it. The diagnosis, treatment and prevention strategies of HPV-related cervical cancer have also been discussed.
Collapse
Affiliation(s)
- Smitha V Bava
- a Department of Biotechnology , University of Calicut , Malappuram , Kerala , India
| | - Arun Kumar T Thulasidasan
- b Cancer Research Program, Division of Cancer Research , Rajiv Gandhi Centre for Biotechnology , Thiruvananthapuram , Kerala , India
| | - Chanickal N Sreekanth
- b Cancer Research Program, Division of Cancer Research , Rajiv Gandhi Centre for Biotechnology , Thiruvananthapuram , Kerala , India
| | - Ruby John Anto
- b Cancer Research Program, Division of Cancer Research , Rajiv Gandhi Centre for Biotechnology , Thiruvananthapuram , Kerala , India
| |
Collapse
|
13
|
Vijakururote L, Suprasert P, Srisomboon J, Siriaunkgul S, Settakorn J, Rewsuwan S. Histologic Outcomes in HPV-Positive and Cervical Cytology- Negative Women - Screening Results in Northern Thailand. Asian Pac J Cancer Prev 2015; 16:7271-5. [PMID: 26514523 DOI: 10.7314/apjcp.2015.16.16.7271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The objective of this study was to determine the prevalence of significant lesions defined as high grade squamous intraepithelial lesions (HSIL), adenocarcinoma in situ (AIS) and invasive carcinoma in women who had HPV-positive and cytology negative co-testing screening results. This retrospective study was conducted in Chiang Mai University Hospital between May, 2013 and August, 2014. Hybrid capture 2 (HC2) was used for HPV testing and conventional Pap smears for cytologic screening. A repeat liquid-based cytology (LBC) was performed in women with such co-testing results followed by colposcopy. Random biopsy was performed in cases of normal colposcopic findings. Further investigations were carried out according to the biopsy or the repeat LBC results. During the study period, 273 women met the criteria and participated in the study. The mean age of these women was 46.4 years with 30% of them reporting more than one partner. The median interval time to colposcopy was 165 days. About 40% showed an abnormality in the repeat cytology. Significant cervical lesions were found in 20 (7.3%) women, including 2 invasive cancers. Of interest was that only 2 of 20 significant lesions were diagnosed by colposcopic examination while the remainder were initially detected by cervical biopsy and abnormal repeat cytology. In conclusion, the prevalence of significant cervical lesions in HPV positive and cytology negative women in Northern Thailand was 7.3%. Further diagnostic work up with repeat cytology follow by colposcopy is recommended. Random biopsy should be performed even when the colposcopic findings are normal.
Collapse
Affiliation(s)
- Linlada Vijakururote
- Division of Gynecologic Pathology, Department of Pathology Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand E-mail :
| | | | | | | | | | | |
Collapse
|
14
|
Kietpeerakool C, Kleebkaow P, Srisomboon J. Human Papillomavirus Genotype Distribution among Thai Women with High-Grade Cervical Intraepithelial Lesions and Invasive Cervical Cancer: a Literature Review. Asian Pac J Cancer Prev 2015. [PMID: 26225645 DOI: 10.7314/apjcp.2015.16.13.5153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Infection with high-risk human papillomavirus (HR-HPV) is an essential cause of cervical cancer. Because of substantial geographical variation in the HPV genotype distribution, data regarding HPV type-specific prevalence for a particular country are mandatory for providing baseline information to estimate effectiveness of currently implemented HPV-based cervical cancer prevention. Accordingly, this review was conducted to evaluate the HR-HPV genotype distribution among Thai women with precancerous cervical lesions i.e. cervical intraepithelial neoplasia grade 2-3 (CIN 2-3), adenocarcinoma in situ (AIS), and invasive cervical cancer by reviewing the available literature. The prevalence of HR-HPV infection among Thai women with CIN 2-3 ranged from 64.8% to 90.1% and the three most common genotypes were HPV 16 (38.5%), HPV 58 (20.0%), and HPV 18 (5.5%). There were high squamous cell carcinoma/CIN 2-3 prevalence ratios in women with CIN 2-3 infected with HPV 33 and HPV 58 (1.40 and 1.38, respectively), emphasizing the importance of these subtypes in the risk of progression to invasive cancer among Thai women. Data regarding the prevalence and genotype distribution of HR-HPV in Thai women with AIS remain unavailable. Interesting findings about the distribution of HPV genotype in cervical cancer among Thai women include: (1) a relatively high prevalence of HPV 52 and HPV 58 in invasive squamous cell carcinoma; (2) the prevalence of HPV 18-related adenocarcinoma is almost double thepreviously reported prevalence, and (3) 75% of neuroendocrine carcinomas are HPV18-positive when taking into account both single and multiple infections.
Collapse
Affiliation(s)
- Chumnan Kietpeerakool
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand E-mail :
| | | | | |
Collapse
|
15
|
Holl K, Nowakowski AM, Powell N, McCluggage WG, Pirog EC, Collas De Souza S, Tjalma WA, Rosenlund M, Fiander A, Castro Sánchez M, Damaskou V, Joura EA, Kirschner B, Koiss R, O'Leary J, Quint W, Reich O, Torné A, Wells M, Rob L, Kolomiets L, Molijn A, Savicheva A, Shipitsyna E, Rosillon D, Jenkins D. Human papillomavirus prevalence and type-distribution in cervical glandular neoplasias: Results from a European multinational epidemiological study. Int J Cancer 2015; 137:2858-68. [PMID: 26096203 PMCID: PMC5034816 DOI: 10.1002/ijc.29651] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 05/19/2015] [Indexed: 01/10/2023]
Abstract
Cervical glandular neoplasias (CGN) present a challenge for cervical cancer prevention due to their complex histopathology and difficulties in detecting preinvasive stages with current screening practices. Reports of human papillomavirus (HPV) prevalence and type-distribution in CGN vary, providing uncertain evidence to support prophylactic vaccination and HPV screening. This study [108288/108290] assessed HPV prevalence and type-distribution in women diagnosed with cervical adenocarcinoma in situ (AIS, N = 49), adenosquamous carcinoma (ASC, N = 104), and various adenocarcinoma subtypes (ADC, N = 461) from 17 European countries, using centralised pathology review and sensitive HPV testing. The highest HPV-positivity rates were observed in AIS (93.9%), ASC (85.6%), and usual-type ADC (90.4%), with much lower rates in rarer ADC subtypes (clear-cell: 27.6%; serous: 30.4%; endometrioid: 12.9%; gastric-type: 0%). The most common HPV types were restricted to HPV16/18/45, accounting for 98.3% of all HPV-positive ADC. There were variations in HPV prevalence and ADC type-distribution by country. Age at diagnosis differed by ADC subtype, with usual-type diagnosed in younger women (median: 43 years) compared to rarer subtypes (medians between 57 and 66 years). Moreover, HPV-positive ADC cases were younger than HPV-negative ADC. The six years difference in median age for women with AIS compared to those with usual-type ADC suggests that cytological screening for AIS may be suboptimal. Since the great majority of CGN are HPV16/18/45-positive, the incorporation of prophylactic vaccination and HPV testing in cervical cancer screening are important prevention strategies. Our results suggest that special attention should be given to certain rarer ADC subtypes as most appear to be unrelated to HPV.
Collapse
Affiliation(s)
| | - Andrzej M Nowakowski
- First Department of Oncologic Gynaecology and Gynaecology, Medical University of Lublin, Poland.,Department of Gynaecology and Oncologic Gynaecology, Military Institute of Medicine, Warsaw, Poland
| | - Ned Powell
- Institute of Cancer and Genetics, HPV Research Group, Cardiff University School of Medicine, Cardiff, Wales, United Kingdom
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Edyta C Pirog
- Department of Pathology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY
| | | | - Wiebren A Tjalma
- Multidisciplinary Breast Clinic-Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - Mats Rosenlund
- IMS Health, Stockholm, Sweden.,Center for Pharmacoepidemiology, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Solna, Sweden
| | - Alison Fiander
- Institute of Cancer and Genetics, HPV Research Group, Cardiff University School of Medicine, Cardiff, Wales, United Kingdom
| | - Maria Castro Sánchez
- Obstetrics and Gynaecology Department, University Hospital Puerto De Hierro Majadahonda, Madrid, Spain
| | - Vasileia Damaskou
- Department of Anatomical Pathology, General Hospital of Patras, Achaia, Greece
| | - Elmar A Joura
- Comprehensive Cancer Center, Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Benny Kirschner
- Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Hvidovre, Copenhagen, Denmark
| | - Robert Koiss
- Department of Obstetrics and Gynecologic Oncology, St. Stephan Hospital, Budapest, Hungary
| | - John O'Leary
- CERVIVA Research Consortium, Funded by the Health Research Board Ireland, Based at the Department of Pathology, The Coombe Women and Infants University Hospital and Trinity College, Dublin, Ireland
| | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Olaf Reich
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Aureli Torné
- Hospital Clinic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Michael Wells
- Department of Oncology, University of Sheffield Medical School, Sheffield, England, United Kingdom
| | - Lukas Rob
- University Hospital Motol, Prague, Czech Republic
| | | | - Anco Molijn
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Alevtina Savicheva
- Laboratory of Microbiology, DO Ott Research Institute of Obstetrics and Gynaecology, St. Petersburg, Russia
| | - Elena Shipitsyna
- Laboratory of Microbiology, DO Ott Research Institute of Obstetrics and Gynaecology, St. Petersburg, Russia
| | | | - David Jenkins
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| |
Collapse
|
16
|
Alemany L, de Sanjosé S, Tous S, Quint W, Vallejos C, Shin HR, Bravo LE, Alonso P, Lima MA, Guimerà N, Klaustermeier J, Llombart-Bosch A, Kasamatsu E, Tatti SA, Felix A, Molina C, Velasco J, Lloveras B, Clavero O, Lerma E, Laco J, Bravo IG, Guarch R, Pelayo A, Ordi J, Andújar M, Sanchez GI, Castellsagué X, Muñoz N, Bosch FX. Time trends of human papillomavirus types in invasive cervical cancer, from 1940 to 2007. Int J Cancer 2013; 135:88-95. [DOI: 10.1002/ijc.28636] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 10/23/2013] [Accepted: 11/04/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Laia Alemany
- Unit of Infections and Cancer; Catalan Institute of Oncology; IDIBELL Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Silvia de Sanjosé
- Unit of Infections and Cancer; Catalan Institute of Oncology; IDIBELL Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Sara Tous
- Unit of Infections and Cancer; Catalan Institute of Oncology; IDIBELL Barcelona Spain
| | - Wim Quint
- DDL Diagnostic Laboratories; Rijswijk The Netherlands
| | | | | | - Luis E. Bravo
- Department of Pathology, Hospital Universitario del Valle; Cali Colombia
| | - Patricia Alonso
- Department of Pathology Hospital General de México, Facultad de Medicina; Universidad Nacional Autónoma de México; México
| | - Marcus A. Lima
- Laboratório de Anatomia Patológica e citologia; Associação de Combate ao Câncer do Brasil Central, Hospital Dr Hélio Angotti; PATMED Uberada Brazil
| | - Núria Guimerà
- DDL Diagnostic Laboratories; Rijswijk The Netherlands
| | - JoEllen Klaustermeier
- Unit of Infections and Cancer; Catalan Institute of Oncology; IDIBELL Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | | | - Elena Kasamatsu
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción; Asunción Paraguay
| | - Silvio A. Tatti
- Department of Gynecology Hospital de Clínicas José de San Martín; Universidad de Buenos Aires; Buenos Aires Argentina
| | - Ana Felix
- Department of Pathology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil; Lisbon Portugal
| | - Carla Molina
- Centro de Oncología Preventiva Facultad de Medicina; Universidad de Chile; Santiago Chile
| | - Julio Velasco
- Department of Pathology, Hospital San Agustín; Avilés Spain
| | - Belen Lloveras
- Department of Pathology, Hospital del Mar; Barcelona Spain
| | - Omar Clavero
- Unit of Infections and Cancer; Catalan Institute of Oncology; IDIBELL Barcelona Spain
| | - Enrique Lerma
- Department of Pathology, Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - Jan Laco
- Fingerland Department of Pathology; Charles University, Faculty of Medicine and Faculty Hospital; Hradec Králové Czech Republic
| | - Ignacio G. Bravo
- Unit of Infections and Cancer; Catalan Institute of Oncology; IDIBELL Barcelona Spain
| | - Rosa Guarch
- Department of Pathology, Hospital Virgen del Camino; Pamplona Spain
| | - Adela Pelayo
- Department of Pathology, Hospital Clínico San Carlos; Madrid Spain
| | - Jaume Ordi
- Department of Pathology, CRESIB Hospital Clínic; University of Barcelona; Spain
| | - Miguel Andújar
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno-Infantil; Las Palmas de Gran Canaria Spain
| | - Gloria I. Sanchez
- Infection and Cancer Group School of Medicine; University of Antioquia; Medellin Colombia
| | - Xavier Castellsagué
- Unit of Infections and Cancer; Catalan Institute of Oncology; IDIBELL Barcelona Spain
| | - Nubia Muñoz
- Emeritus Professor at the Cancer Institute of Colombia, Bogotá, Colombia
| | - F. Xavier Bosch
- Unit of Infections and Cancer; Catalan Institute of Oncology; IDIBELL Barcelona Spain
| | | |
Collapse
|
17
|
Human papillomavirus in high-grade cervical lesions: Austrian data of a European multicentre study. Wien Klin Wochenschr 2013; 125:591-9. [DOI: 10.1007/s00508-013-0403-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 07/07/2013] [Indexed: 10/26/2022]
|
18
|
|
19
|
Joura E. Researcher of the month, Oktober 2012. Wien Klin Wochenschr 2012; 124:733-4. [DOI: 10.1007/s00508-012-0260-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
20
|
Kietpeerakool C, Khunamornpong S, Srisomboon J, Kasunan A, Sribanditmongkol N, Siriaungkul S. Predictive value of negative cone margin status for risk of residual disease among women with cervical adenocarcinoma in situ. Int J Gynaecol Obstet 2012; 119:266-9. [PMID: 22939281 DOI: 10.1016/j.ijgo.2012.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 06/22/2012] [Accepted: 08/02/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the value of negative cone margins in predicting residual disease in women with adenocarcinoma in situ (ACIS). METHODS Data were retrospectively analyzed from 60 women with ACIS who underwent conization at Chiang Mai University Hospital between March, 1998, and December, 2010. Negative margin status was defined as absence of neoplastic epithelium at all margins, coupled with presence of normal cervical epithelium. The association between the incidence of residual lesions and cone margin status was analyzed via χ(2) or Fisher exact test. RESULTS When adjusted for age and completeness of visualization of the cervical squamocolumnar junction during colposcopy, women who underwent loop electrosurgical excision procedure were 4 times more likely to have positive cone margins than those who underwent cold-knife conization (95% CI, 1.13-16.43). Residual disease was not found among 26 women who had negative cone margins, but was observed in 17 (65.4%) of 26 women with positive cone margins (P<0.001). CONCLUSION Women with ACIS who had negative cone margins were found to have a notably low risk of residual disease. Adherence to the standard method of cone sampling and criteria for negative margin status might contribute to a high predictive value of negative cone margins.
Collapse
Affiliation(s)
- Chumnan Kietpeerakool
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | | | | | | | | | | |
Collapse
|
21
|
Guan P, Howell-Jones R, Li N, Bruni L, de Sanjosé S, Franceschi S, Clifford GM. Human papillomavirus types in 115,789 HPV-positive women: a meta-analysis from cervical infection to cancer. Int J Cancer 2012; 131:2349-59. [PMID: 22323075 DOI: 10.1002/ijc.27485] [Citation(s) in RCA: 625] [Impact Index Per Article: 52.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 01/27/2012] [Indexed: 11/08/2022]
Abstract
Genotyping may improve risk stratification of high-risk (HR) human papillomavirus (HPV)-positive women in cervical screening programs; however, prospective data comparing the natural history and carcinogenic potential of individual HR types remain limited. A meta-analysis of cross-sectional HR HPV-type distribution in 115,789 HPV-positive women was performed, including 33,154 normal cytology, 6,810 atypical squamous cells of undetermined significance (ASCUS), 13,480 low-grade squamous intraepithelial lesions (LSIL) and 6,616 high-grade SIL (HSIL) diagnosed cytologically, 8,106 cervical intraepithelial neoplasia grade 1 (CIN1), 4,068 CIN2 and 10,753 CIN3 diagnosed histologically and 36,374 invasive cervical cancers (ICCs) from 423 PCR-based studies worldwide. No strong differences in HPV-type distribution were apparent between normal cytology, ASCUS, LSIL or CIN1. However, HPV16 positivity increased steeply from normal/ASCUS/LSIL/CIN1 (20-28%), through CIN2/HSIL (40/47%) to CIN3/ICC (58/63%). HPV16, 18 and 45 accounted for a greater or equal proportion of HPV infections in ICC compared to normal cytology (ICC:normal ratios = 3.07, 1.87 and 1.10, respectively) and to CIN3 (ICC:CIN3 ratios = 1.08, 2.11 and 1.47, respectively). Other HR types accounted for important proportions of HPV-positive CIN2 and CIN3, but their contribution dropped in ICC, with ICC:normal ratios ranging from 0.94 for HPV33 down to 0.16 for HPV51. ICC:normal ratios were particularly high for HPV45 in Africa (1.85) and South/Central America (1.79) and for HPV58 in Eastern Asia (1.36). ASCUS and LSIL appear proxies of HPV infection rather than cancer precursors, and even CIN3 is not entirely representative of the types causing ICC. HPV16 in particular, but also HPV18 and 45, warrant special attention in HPV-based screening programs.
Collapse
Affiliation(s)
- Peng Guan
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
Human papillomavirus (HPV)-related cancers are a major worldwide public health concern. Virtually all cervical cancer is HPV related, with 70% caused by HPV16 and -18. Variable proportions of certain noncervical cancers (e.g., anal, vulvar, and oropharyngeal) are HPV related; more than 90% of the HPV-related ones are caused by HPV16, -18. The HPV-related cancers are dominated by cervical cancer in the developing world, where cervical cancer screening is limited. In this setting, widespread uptake of current HPV vaccines by adolescent girls could reduce this cancer's incidence and mortality by approximately two-thirds, with cost-effective screening programs of adult women having the potential to reduce mortality more rapidly. In the industrialized world, some noncervical HPV-related cancers, especially oropharyngeal, are rapidly increasing, and now rival the incidence of cervical cancer, whose rates continue to decline thanks to established cervical screening programs. Therefore, reducing HPV-associated noncervical cancers with HPV vaccination has greater importance in the industrialized world, especially because there are no approved screening programs for these cancers. Preventing the substantial number of noncervical HPV cancers in men will require either "herd" immunity through high-vaccination rates in females or male vaccination. Current HPV vaccination can complement cervical screening in protecting against cervical cancer and may permit the safe reduction of screening intensity in industrialized countries. Second-generation HPV vaccines (active against a broader array of cervical cancer-related HPV types) could prevent an even higher proportion of cervical precancer and cancer and might permit further reductions in screening intensity.
Collapse
Affiliation(s)
- Douglas R Lowy
- Laboratory of Cellular Oncology, National Cancer Institute, 37 Convent Drive, Bethesda, MD 20892, USA.
| | | |
Collapse
|