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Lu J, Han S, Li Y, Na J, Wang J. A study on the correlation between the prognosis of HPV infection and lesion recurrence after cervical conization. Front Microbiol 2023; 14:1266254. [PMID: 37869677 PMCID: PMC10587556 DOI: 10.3389/fmicb.2023.1266254] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Persistent human papillomavirus infection is an important factor in the development of cervical cancer, which is usually a long process evolving from the development of squamous intraepithelial lesions (SIL), also referred to as cervical intraepithelial neoplasia (CIN). Local treatment of advanced squamous intraepithelial lesions, also regarded as High-Grade Squamous Intraepithelial Lesion, may be effective in preventing cancer. Objective To promptly identify high-risk patients with a tendency to recurrence. Methods We retrospectively analyzed the clinical data of 300 patients with high-grade squamous intraepithelial lesions of the cervix admitted to the Second Affiliated Hospital of Dalian Medical University from 2019 to 2020 to investigate the relationship between recurrence of cervical lesions and postoperative regression of HPV infection, as well as other related risk factors. Results We found that the HPV-negative rates were 81.81, 85.71, and 90.91% at 6, 12, and 24 months, respectively, and the average lesion recurrence rate was 8.16%, with a median time to recurrence of 14 months in patients undergoing CKC for HSIL. The risk of cervical squamous intraepithelial lesions was highest in patients with HPV16. Patients over 61 years of age had the lowest postoperative HPV-negative rate. The conversion rate was significantly lower in patients with multiple HPV genotypes than in those with single HPV infection (p < 0.05). The probability of recurrence was higher in patients with the same HPV infection genotype before and after surgery than in patients with different infection genotypes before and after surgery (p < 0.05). Conclusion Combined with the literature review, we believe that patients aged ≥50 years, with ≥3 pregnancies and births, a history of smoking, and consistent genotypes of preoperative and postoperative HPV infection in cervical conization have more HPV re-infection or persistent infection, and that these factors may be high-risk factors for lesion recurrence. For patients with possible potential high-risk factors, we need to carry out individualized follow-up and focused management, take timely and effective management measures, optimize the treatment plan, reduce the recurrence rate, prevent HSIL and cervical cancer, improve the quality of patient's survival, and improve the prognosis.
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Affiliation(s)
| | | | | | - Jing Na
- Department of Gynecology and Obstetrics, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jun Wang
- Department of Gynecology and Obstetrics, Second Affiliated Hospital of Dalian Medical University, Dalian, China
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Condrat CE, Cretoiu D, Radoi VE, Mihele DM, Tovaru M, Bordea CI, Voinea SC, Suciu N. Unraveling Immunological Dynamics: HPV Infection in Women-Insights from Pregnancy. Viruses 2023; 15:2011. [PMID: 37896788 PMCID: PMC10611104 DOI: 10.3390/v15102011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
During pregnancy, hormonal and immune adaptations are vital for supporting the genetically distinct fetus during elevated infection risks. The global prevalence of HPV necessitates its consideration during pregnancy. Despite a seemingly mild immune response, historical gestational viral infections underscore its significance. Acknowledging the established HPV infection risks during pregnancy, our review explores the unfolding immunological changes in pregnant women with HPV. Our analysis aims to uncover strategies for safely modulating the immune system, mitigating adverse pregnancy consequences, and enhancing maternal and child health. This comprehensive narrative review delves into the existing knowledge and studies on this topic.
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Affiliation(s)
- Carmen Elena Condrat
- Department of Obstetrics and Gynecology, Polizu Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (C.E.C.)
| | - Dragos Cretoiu
- Department of Genetics, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (D.C.); (V.E.R.)
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania
| | - Viorica Elena Radoi
- Department of Genetics, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (D.C.); (V.E.R.)
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania
| | - Dana Mihaela Mihele
- Department of Dermatology, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
- Dermatology Department, Victor Babes Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania
| | - Mihaela Tovaru
- Department of Dermatology, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
- Dermatology Department, Victor Babes Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania
| | - Cristian Ioan Bordea
- Department of Surgical Oncology, Prof. Dr. Alexandru Trestioreanu Oncology Institute, Carol Davila University of Medicine and Pharmacy, 252 Fundeni Rd., 022328 Bucharest, Romania
| | - Silviu Cristian Voinea
- Department of Surgical Oncology, Prof. Dr. Alexandru Trestioreanu Oncology Institute, Carol Davila University of Medicine and Pharmacy, 252 Fundeni Rd., 022328 Bucharest, Romania
| | - Nicolae Suciu
- Department of Obstetrics and Gynecology, Polizu Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (C.E.C.)
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania
- Department of Obstetrics and Gynecology, Polizu Clinical Hospital, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania
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Minalt N, Caldwell A, Yedlicka GM, Joseph S, Robertson SE, Landrum LM, Peipert JF. Association between intrauterine device use and endometrial, cervical, and ovarian cancer: an expert review. Am J Obstet Gynecol 2023; 229:93-100. [PMID: 37001577 DOI: 10.1016/j.ajog.2023.03.039] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/10/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023]
Abstract
The intrauterine device is one of the most effective forms of contraception. Use of the intrauterine device has increased in the United States over the last 2 decades. Two formulations are commercially available in the United States: the levonorgestrel-releasing intrauterine device and the copper intrauterine device. The levonorgestrel intrauterine device releases progestin, causing endometrial suppression and cervical mucus thickening, whereas the primary mechanism of action of the copper intrauterine device is to create a local inflammatory response to prevent fertilization. Whereas the protective effects of combined hormonal contraception against ovarian and endometrial cancer, and of tubal sterilization against ovarian cancer are generally accepted, less is known about the effects of modern intrauterine devices on the development of gynecologic malignancies. The best evidence for a protective effect of intrauterine device use against cancer incidence pertains to levonorgestrel intrauterine devices and endometrial cancer, although studies suggest that both copper intrauterine devices and levonorgestrel intrauterine devices reduce endometrial cancer risk. This is supported by the proposed dual mechanisms of action including both endometrial suppression and a local inflammatory response. Studies on the relationship between intrauterine device use and ovarian cancer risk show conflicting results, although most data suggest reduced risk of ovarian cancer in intrauterine device users. The proposed biological mechanisms of ovarian cancer reduction (foreign-body inflammatory response, increased pH, antiestrogenic effect, ovulation suppression) vary by type of intrauterine device. Whereas it has been well established that use of copper intrauterine devices confers a lower risk of cervical intraepithelial neoplasms, the effect of levonorgestrel intrauterine device use on cervical cancer remains unclear. Older studies have linked its use to a higher incidence of cervical dysplasia, but more recent literature has found a decrease in cervical cancer with intrauterine device use. Various mechanisms of protection are postulated, including device-related inflammatory response in the endocervical canal and prostaglandin-mediated immunosurveillance. Overall, the available evidence suggests that both levonorgestrel intrauterine devices and copper intrauterine devices reduce gynecologic cancer risk. Whereas there is support for the reduction of endometrial cancer risk with hormonal and copper intrauterine device use, and reduction of cervical cancer risk with copper intrauterine device use, evidence in support of risk reduction with levonorgestrel intrauterine device use for cervical and ovarian cancers is less consistent.
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Affiliation(s)
- Nicole Minalt
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Amy Caldwell
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Grace M Yedlicka
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Sophia Joseph
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Sharon E Robertson
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Lisa M Landrum
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Jeffrey F Peipert
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN.
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Kusakabe M, Taguchi A, Sone K, Mori M, Osuga Y. Carcinogenesis and management of human papillomavirus-associated cervical cancer. Int J Clin Oncol 2023:10.1007/s10147-023-02337-7. [PMID: 37294390 PMCID: PMC10390372 DOI: 10.1007/s10147-023-02337-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/01/2023] [Indexed: 06/10/2023]
Abstract
Approximately 95% of cervical cancer are caused by human papillomavirus (HPV) infection. Although it is estimated that HPV-associated cervical cancer will decrease with the widespread use of HPV vaccine, it may take time for HPV-associated cervical cancer to be eliminated. For the appropriate management of HPV-associated cervical cancer, it is important to understand the detailed mechanisms of cervical cancer development. First, the cellular origin of most cervical cancers is thought to be cells in the squamocolumnar junction (SCJ) of the uterine cervix. Therefore, it is important to understand the characteristics of SCJ for cervical cancer screening and treatment. Second, cervical cancer is caused by high risk HPV (HR-HPV) infection, however, the manner of progression to cervical cancer differs depending on the type of HR-HPV: HPV16 is characterized by a stepwise carcinogenesis, HPV18 is difficult to detect in precancerous lesions, and HPV52, 58 tends to remain in the state of cervical intraepithelial neoplasia (CIN). Third, in addition to the type of HPV, the involvement of the human immune response is also important in the progression and regression of cervical cancer. In this review, we demonstrate the carcinogenesis mechanism of HPV-associated cervical cancer, management of CIN, and the current treatment of CIN and cervical cancer.
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Affiliation(s)
- Misako Kusakabe
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ayumi Taguchi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan.
- Laboratory of Human Single Cell Immunology, World Premier International Immunology Frontier Research Center (WPI-IFReC), Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Kenbun Sone
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mayuyo Mori
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan
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Maru Y, Kawata A, Taguchi A, Ishii Y, Baba S, Mori M, Nagamatsu T, Oda K, Kukimoto I, Osuga Y, Fujii T, Hippo Y. Establishment and Molecular Phenotyping of Organoids from the Squamocolumnar Junction Region of the Uterine Cervix. Cancers (Basel) 2020; 12:E694. [PMID: 32183493 DOI: 10.3390/cancers12030694] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 12/13/2022] Open
Abstract
The metaplastic epithelium of the transformation zone (TZ) including the squamocolumnar junction (SCJ) of the uterine cervix is a prime target of human papilloma virus (HPV) infection and subsequent cancer development. Due to the lack of adequate in vitro models for SCJ, however, investigations into its physiological roles and vulnerability to carcinogenesis have been limited. By using Matrigel-based three-dimensional culture techniques, we propagated organoids derived from the normal SCJ region, along with metaplastic squamous cells in the TZ. Consisting predominantly of squamous cells, organoids basically exhibited a dense structure. However, at least in some organoids, a small but discrete population of mucin-producing endocervix cells co-existed adjacent to the squamous cell population, virtually recapitulating the configuration of SCJ in a TZ background. In addition, transcriptome analysis confirmed a higher expression level of many SCJ marker genes in organoids, compared to that in the immortalized cervical cell lines of non-SCJ origin. Thus, the obtained organoids appear to mimic cervical SCJ cells and, in particular, metaplastic squamous cells from the TZ, likely providing a novel platform in which HPV-driven cervical cancer development could be investigated.
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Loopik DL, IntHout J, Melchers WJG, Massuger LFAG, Bekkers RLM, Siebers AG. Oral contraceptive and intrauterine device use and the risk of cervical intraepithelial neoplasia grade III or worse: a population-based study. Eur J Cancer 2019; 124:102-109. [PMID: 31760309 DOI: 10.1016/j.ejca.2019.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/02/2019] [Accepted: 10/10/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Hormonal contraceptive use has been associated with the development of cervical cancer, although inconsistent results are reported on the association with intrauterine device (IUD) use. The aim of this study was to evaluate the association between the type of contraceptive use and the development of cervical intraepithelial neoplasia grade III or worse (CIN3+). METHODS A retrospective population-based cohort study including women aged 29-44 years attending the cervical cancer screening program with normal cytology between 2005 and 2009 identified from the Dutch Pathology Registry. Subgroups with at least 5 years registered use of an oral contraceptive (OC) or IUD were compared with non-users. Risk ratios of CIN3+ were estimated per contraceptive type. RESULTS 702,037 women were included with a median follow-up of 9.7 years, of which 6705 (0.96%) and 559 (0.08%) women developed CIN3 and cervical cancer, respectively. IUD use was associated with an increased risk of developing CIN3+ (risk ratio (RR) 1.51, 95% confidence interval (CI) 1.32-1.74), and OC use was associated with an increased risk of developing CIN3+ (RR 2.77, 95%CI 2.65-3.00) and cervical cancer (RR 2.06, 95%CI 1.52-2.79). The risk of developing CIN3+ and cervical cancer was higher for OC users compared with IUD users (RR 1.83, 95%CI 1.60-2.09 and RR 1.70, 95%CI 1.00-2.90, respectively). CONCLUSIONS Both OC use and IUD use were associated with an increased risk of developing CIN3+. However, for women with a contraceptive wish, an IUD seems safer than an OC as the risk of developing CIN3+ and cervical cancer was higher for OC users.
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Affiliation(s)
- Diede L Loopik
- Department of Obstetrics and Gynaecology, Radboud Institute for Molecular Life Sciences, Radboud university medical center, PO Box 9101, 6500HB, Nijmegen, the Netherlands.
| | - Joanna IntHout
- Department of Biostatistics, Radboud Institute for Health Sciences, Radboud university medical center, PO Box 9101, 6585KM, Nijmegen, the Netherlands.
| | - Willem J G Melchers
- Department of Medical Microbiology, Radboud university medical center, PO Box 9101, 6500HB, Nijmegen, the Netherlands.
| | - Leon F A G Massuger
- Department of Obstetrics and Gynaecology, Radboud university medical center, PO Box 9101, 6500HB, Nijmegen, the Netherlands.
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, Catharina Hospital, PO Box 1350, 5602ZA, Eindhoven, the Netherlands.
| | - Albert G Siebers
- Department of Pathology, Radboud university medical center, PO Box 9101, 6500HB, Nijmegen, the Netherlands; PALGA, Randhoeve 225a, 3995 GA, Houten, the Netherlands.
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Paul P, Koh WP, Jin A, Michel A, Waterboer T, Pawlita M, Wang R, Yuan JM, Butler LM. Soy and tea intake on cervical cancer risk: the Singapore Chinese Health Study. Cancer Causes Control 2019; 30:847-857. [PMID: 31154549 DOI: 10.1007/s10552-019-01173-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 08/16/2016] [Accepted: 04/13/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Soy isoflavones and tea catechins have immunomodulating and chemopreventive properties relevant for cervical carcinogenesis; however, there are limited epidemiologic data on the relationship of soy and tea consumption with cervical cancer risk. The aim of our study was to examine effects of soy and tea intake on cervical cancer risk among Singapore Chinese women. METHODS The association between intake of soy and tea drinking and cervical cancer risk was investigated in a prospective, population-based cohort of 30,744 Chinese women in Singapore with an average 16.7 years of follow-up and 312 incident cervical cancer cases. Multivariable proportional hazard models were used to estimate hazard ratio (HR) and 95% confidence interval (CI) of cervical cancer associated with intake levels of soy and tea. RESULTS High intake of soy alone was associated with a statistically borderline significant 20% reduced risk of cervical cancer (HR 0.80, 95% CI 0.61, 1.05) while green tea alone was not (HR 0.97, 95% CI: 0.76, 1.22). In stratified analysis, high intake of soy was associated with a statistically significant decrease in cervical cancer risk among green tea drinkers (HR 0.43; 95% CI 0.28, 0.69) but not among non-drinkers of green tea. The difference in the soy-cervical cancer risk association between green tea drinkers and non-drinkers was statistically significant (p for interaction = 0.004). This inverse association between soy intake and cervical cancer risk remained after further adjustment for human papillomavirus serostatus. Black tea consumption was not associated with cervical cancer risk. CONCLUSIONS These findings suggest that a protective effect of soy against cervical cancer development may depend on green tea constituents.
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Affiliation(s)
- Proma Paul
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St, Pittsburgh, PA, 15261, USA.
| | - Woon-Puay Koh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Aizhen Jin
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Angelika Michel
- Division of Molecular Diagnostics of Oncogenic Infections, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tim Waterboer
- Division of Molecular Diagnostics of Oncogenic Infections, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Pawlita
- Division of Molecular Diagnostics of Oncogenic Infections, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Renwei Wang
- Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Jian-Min Yuan
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St, Pittsburgh, PA, 15261, USA
- Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Lesley M Butler
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St, Pittsburgh, PA, 15261, USA
- Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
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Hong DK, Kim SA, Lim KT, Lee KH, Kim TJ, So KA. Clinical outcome of high-grade cervical intraepithelial neoplasia during pregnancy: A 10-year experience. Eur J Obstet Gynecol Reprod Biol 2019; 236:173-176. [PMID: 30933887 DOI: 10.1016/j.ejogrb.2019.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/03/2019] [Revised: 03/20/2019] [Accepted: 03/23/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the clinical outcome of high-grade cervical intraepithelial neoplasia (CIN) diagnosed by colposcopy-directed biopsy during pregnancy and to evaluate the risk factors for persistent disease. STUDY DESIGN This retrospective study included pregnant women who were diagnosed with CIN2+ by colposcopy-directed biopsy from January 2005 to December 2014. The clinical characteristics, histopathologic results, and human papillomavirus (HPV) test results were reviewed. The final histopathologic result after delivery was compared with the initial diagnosis to determine disease progression, persistence, or regression. RESULTS During the 10-year period, 215 pregnant women were diagnosed with high-grade CIN (75 CIN2, 140 CIN3) by colposcopy-directed biopsy. The mean age of the patients was 30.4 years. A total of 187 patients (87.0%) had high-risk HPV infections, with 76 (35.3%) infections identified as HPV genotype 16 or 18. Excisional procedures for diagnosis and treatment were not performed during pregnancy. The histopathologic results of 160 patients (normal in 43, CIN1 in 10, CIN2 in 15, CIN3 in 89, and invasive cancer in 3) were evaluated during the postpartum period. Multivariate logistic regression analysis was performed, and postpartum high-risk HPV infection (OR 5.09; 95% CI 2.15-12.05; P < 0.001) was identified as a significant independent predictor of CIN2+ persistence. CONCLUSIONS Conservative management of CIN2-3 during pregnancy is acceptable. However, persistent high-risk HPV infection is a major risk factor for CIN2+ persistence. Close follow-up with HPV testing, and postpartum colposcopy evaluation are necessary.
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Affiliation(s)
- Da Kyung Hong
- Department of Obstetrics and Gynecology, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea; Department of Obstetrics & Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
| | - Seon Ah Kim
- Department of Obstetrics and Gynecology, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea
| | - Kyung Taek Lim
- Department of Obstetrics and Gynecology, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea; Department of Obstetrics and Gynecology, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ki Heon Lee
- Department of Obstetrics and Gynecology, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea; Department of Obstetrics & Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
| | - Tae Jin Kim
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kyeong A So
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Republic of Korea.
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Zhang W, Chen M, Cheng H, Shen Q, Wang Y, Zhu X. The role of calgranulin B gene on the biological behavior of squamous cervical cancer in vitro and in vivo. Cancer Manag Res 2018; 10:323-338. [PMID: 29497331 PMCID: PMC5818869 DOI: 10.2147/cmar.s153036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Indexed: 01/05/2023] Open
Abstract
Objective The objective of the study was to explore the role of calgranulin B gene on the biological behavior of squamous cervical cancer. Methods Differential transcription in calgranulin B gene between human papillomavirus (HPV)-positive and negative cervical cancer groups was identified, and the relationship between calgranulin B gene and matrix metalloproteinase (MMP) genes were explored using The Cancer Genome Atlas database. Subsequently, the role of calgranulin B on the cell proliferation, apoptosis, invasion and migration was investigated, through overexpression and/or underexpression of calgranulin B in cervical cancer cells. In addition, the effect of calgranulin B on the growth of the cervical cancer was studied via constructing xenograft model in BALB/c nude mice that either overexpressed or underexpressed calgranulin B. Results Calgranulin B gene transcription in cervical cancer was highly correlated with the high-risk HPV-16 and HPV-45. In addition, overexpression of calgranulin B increased cell proliferation, invasion and migration, whereas it did not significantly affect cell apoptosis. This effect was also confirmed by calgranulin B knockdown assay. Additionally, we found that the transcription of calgranulin B gene was negatively correlated with MMP15 and MMP24 genes, but positively associated with MMP25 genes in cervical cancer. Furthermore, calgranulin B significantly promoted the growth of cervical cancer in vivo. Conclusion Calgranulin B promotes cell proliferation, migration and invasion of squamous cervical cancer, possibly via regulation of MMPs. Whether there are synergistic actions between calgranulin B and HPV-16/HPV-45 infection on the squamous cervical carcinogenesis or progression need further study.
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Affiliation(s)
- Wenwen Zhang
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Miaomiao Chen
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Huihui Cheng
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Qi Shen
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Ying Wang
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xueqiong Zhu
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
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Bedoya-Pilozo CH, Medina Magües LG, Espinosa-García M, Sánchez M, Parrales Valdiviezo JV, Molina D, Ibarra MA, Quimis-Ponce M, España K, Párraga Macias KE, Cajas Flores NV, Orlando SA, Robalino Penaherrera JA, Chedraui P, Escobar S, Loja Chango RD, Ramirez-Morán C, Espinoza-Caicedo J, Sánchez-Giler S, Limia CM, Alemán Y, Soto Y, Kouri V, Culasso ACA, Badano I. Molecular epidemiology and phylogenetic analysis of human papillomavirus infection in women with cervical lesions and cancer from the coastal region of Ecuador. Rev Argent Microbiol 2017; 50:136-146. [PMID: 29157596 DOI: 10.1016/j.ram.2017.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/12/2016] [Revised: 05/28/2017] [Accepted: 06/25/2017] [Indexed: 11/26/2022] Open
Abstract
The aim of the present study was to gather information regarding the molecular epidemiology of Human papillomavirus (HPV) and related risk factors in a group of women with low- and high-grade cervical lesions and cancer from the coastal region of Ecuador. In addition, we studied the evolution of HPV variants from the most prevalent types and provided a temporal framework for their emergence, which may help to trace the source of dissemination within the region. We analyzed 166 samples, including 57 CIN1, 95 CIN2/3 and 14 cancer cases. HPV detection and typing was done by PCR-sequencing (MY09/MY11). HPV variants and estimation of the time to most recent common ancestor (tMRCA) was assessed through phylogeny and coalescence analysis. HPV DNA was found in 54.4% of CIN1, 74.7% of CIN2/3 and 78.6% of cancer samples. HPV16 (38.9%) and HPV58 (19.5%) were the most prevalent types. Risk factors for the development of cervical lesions/cancer were the following: three or more pregnancies (OR=4.3), HPV infection (OR=3.7 for high-risk types; OR=3.5 for HPV16), among others. With regard to HPV evolution, HPV16 isolates belonged to lineages A (69%) and D (31%) whereas HPV58 isolates belonged only to lineage A. The period of emergence of HPV16 was in association with human populations (tMRCA=91052 years for HPV16A and 27000 years for HPV16D), whereas HPV58A preceded Homo sapiens evolution (322257 years). This study provides novel data on HPV epidemiology and evolution in Ecuador, which will be fundamental in the vaccine era.
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Affiliation(s)
- Cesar H Bedoya-Pilozo
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador; Escuela Superior Politécnica del Litoral, ESPOL, Laboratorio de Biomedicina - Facultad de Ciencias de la Vida (FCV), Campus Gustavo Galindo, Km 30.5 Vía Perimetral, Guayaquil, Ecuador.
| | - Lex G Medina Magües
- Escuela Superior Politécnica del Litoral, ESPOL, Laboratorio de Biomedicina - Facultad de Ciencias de la Vida (FCV), Campus Gustavo Galindo, Km 30.5 Vía Perimetral, Guayaquil, Ecuador
| | - Maylen Espinosa-García
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - Martha Sánchez
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - Johanna V Parrales Valdiviezo
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - Denisse Molina
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - María A Ibarra
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - María Quimis-Ponce
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - Karool España
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - Karla E Párraga Macias
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - Nancy V Cajas Flores
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - Solon A Orlando
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador; Universidad Agraria del Ecuador, Av. 25 de Julio y Pio Jaramillo, P.O. BOX 09-04-100, Guayaquil, Ecuador
| | - Jorge A Robalino Penaherrera
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - Peter Chedraui
- Hospital Gineco-Obstétrico Enrique C. Sotomayor, Guayaquil, Ecuador
| | - Saul Escobar
- Institute of Biomedicine, Facultad Ciencias Médicas, Universidad Católica de Guayaquil, PO Box 09-01-4671, Guayaquil, Ecuador
| | - Rita D Loja Chango
- Institute of Biomedicine, Facultad Ciencias Médicas, Universidad Católica de Guayaquil, PO Box 09-01-4671, Guayaquil, Ecuador
| | - Cecibel Ramirez-Morán
- Institute of Biomedicine, Facultad Ciencias Médicas, Universidad Católica de Guayaquil, PO Box 09-01-4671, Guayaquil, Ecuador
| | - Jasson Espinoza-Caicedo
- Institute of Biomedicine, Facultad Ciencias Médicas, Universidad Católica de Guayaquil, PO Box 09-01-4671, Guayaquil, Ecuador
| | - Sunny Sánchez-Giler
- Facultad de Ciencias Médicas, Universidad Especialidades Espíritu Santo, Km 2,5 vía Samborondón, Ecuador
| | - Celia M Limia
- Sexually Transmitted Diseases Laboratory, Department of Virology, Institute of Tropical Medicine "Pedro Kouri", Autopista Novia del Mediodia, Km 6 ½, La Lisa, Marianao 13, PO Box 601, Havana City, Cuba
| | - Yoan Alemán
- Sexually Transmitted Diseases Laboratory, Department of Virology, Institute of Tropical Medicine "Pedro Kouri", Autopista Novia del Mediodia, Km 6 ½, La Lisa, Marianao 13, PO Box 601, Havana City, Cuba
| | - Yudira Soto
- Sexually Transmitted Diseases Laboratory, Department of Virology, Institute of Tropical Medicine "Pedro Kouri", Autopista Novia del Mediodia, Km 6 ½, La Lisa, Marianao 13, PO Box 601, Havana City, Cuba
| | - Vivian Kouri
- Sexually Transmitted Diseases Laboratory, Department of Virology, Institute of Tropical Medicine "Pedro Kouri", Autopista Novia del Mediodia, Km 6 ½, La Lisa, Marianao 13, PO Box 601, Havana City, Cuba
| | - Andrés C A Culasso
- Investigador Asistente CONICET, Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Rivadavia 1917, (C1033AAJ) Caba, Argentina; Cátedra de Virología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Junin 954, 4to piso, Capital Federal, (C1113AAD) Buenos Aires, Argentina
| | - Inés Badano
- Investigador Asistente CONICET, Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Rivadavia 1917, (C1033AAJ) Caba, Argentina; Laboratorio de Biología Molecular Aplicada, FCEQyN, Universidad Nacional de Misiones, Av. Mariano Moreno 1375, 3300 Posadas, Misiones, Argentina; Yachay EP, Secretaría de Educación Superior, Ciencia, Tecnología e Innovación, 9 de Octubre N22-64 y Ramírez Dávalos, Casa Patrimonial, Ecuador
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Abstract
The concept of cancer stem cells (CSC) has been established over the past decade or so, and their role in carcinogenic processes has been confirmed. In this review, we focus on cervical CSCs, including (1) their purported origin, (2) markers used for cervical CSC identification, (3) alterations to signalling pathways in cervical cancer and (4) the cancer stem cell niche. Although cervical CSCs have not yet been definitively identified and characterized, future studies pursuing them as therapeutic targets may provide novel insights for treatment of cervical cancer.
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Affiliation(s)
- Tingting Yao
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.,Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, 510120, China
| | - Rongbiao Lu
- Department of Dermatology and Venereology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510630, China
| | - Yizhen Zhang
- Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Ya Zhang
- Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Chenyang Zhao
- Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Rongchun Lin
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Zhongqiu Lin
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
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Zhang P, Yin H, Wang S, Wei Y, Peng N, Bi W, Wang X. Different effects of H2O2 treatment on cervical squamous carcinoma cells and adenocarcinoma cells. Arch Med Sci 2015; 11:1308-13. [PMID: 26788095 PMCID: PMC4697061 DOI: 10.5114/aoms.2015.56356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 01/23/2014] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION This study aims to compare the antioxidant abilities of cervical squamous carcinoma cells and cervical adenocarcinoma cells and to study the related mechanisms. MATERIAL AND METHODS Cervical squamous carcinoma and adenocarcinoma cells were treated with H2O2. Cell proliferation was determined with the MTT assay. The reactive oxygen species (ROS) level was detected by the 2',7'-dichlorofluorescein-diacetate (DCFH-DA) method. The 5,5'-dithiobis-2-nitrobenzoic acid (DTNB) method was performed to measure intracellular concentrations of reduced glutathione (GSH) and oxidized glutathione (GSSG). The nitrite formation method, the molybdate colorimetric method, and the DTNB colorimetric method were used to determine activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), respectively. RESULTS Compared with untreated control cells, cell proliferation of cervical squamous carcinoma cells and cervical adenocarcinoma cells was significantly inhibited by H2O2 treatment (p < 0.05). Reactive oxygen species levels and GSSG levels were significantly increased (p < 0.01), whereas GSH levels were significantly decreased (p < 0.05 or 0.01) in both cells after H2O2 treatment. Thus the ratio of GSH/GSSG was significantly decreased by H2O2 treatment in both cells (p < 0.01). In addition, H2O2 treatment significantly increased activities of SOD, CAT, and GPx in both cells (p < 0.05 or 0.01). Furthermore, the above-mentioned changes induced by H2O2 treatment were more dramatic in cervical squamous carcinoma cells. CONCLUSIONS The antioxidant ability of cervical squamous carcinoma cells is lower than that of cervical adenocarcinoma cells, which may be related to the increased ROS levels in cervical squamous carcinoma cells induced by H2O2 treatments.
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Affiliation(s)
- Peihai Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Haiqin Yin
- Department of Obstetrics and Gynecology, Jinan Central Hospital, Shandong University, Jinan, Shandong, China
| | - Sie Wang
- Department of Obstetrics and Gynecology, Jinan Central Hospital, Shandong University, Jinan, Shandong, China
| | - Yuping Wei
- Institute of Biochemistry and Molecular Biology, School of Medicine, Shandong University, Jinan, Shandong, China
| | - Nan Peng
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Wenxiang Bi
- Institute of Biochemistry and Molecular Biology, School of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaoyuan Wang
- Department of Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
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Trottier H, Mayrand MH, Baggio ML, Galan L, Ferenczy A, Villa LL, Franco EL. Risk of Human Papillomavirus (HPV) Infection and Cervical Neoplasia after Pregnancy. BMC Pregnancy Childbirth 2015; 15:244. [PMID: 26446835 PMCID: PMC4597450 DOI: 10.1186/s12884-015-0675-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 10/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parity is well established as a risk factor for cervical cancer. It is not clear, however, how pregnancy influences the natural history of HPV infection and cervical neoplasia. Our objective was to study the risk of HPV infection and cervical squamous intraepithelial lesions (SIL) after pregnancy. METHODS We used the Ludwig-McGill cohort study which includes 2462 women recruited in Sao Paulo, Brazil in 1993-97 and followed for up to 10 years. Cellular specimens were collected every 4-6 months for Pap cytology and HPV detection and genotyping by a polymerase chain reaction protocol. Study nurses recorded pregnancy occurrence during follow-up. HPV and Pap results from pregnant women were available before and after, but not during pregnancy. The associations between pregnancy and post-partum HPV infection/SIL were studied using generalized estimating equation models with logistic link. Adjusted odds ratios (OR) were estimated with empirical adjustment for confounding. RESULTS We recorded 122 women with a history of pregnancy during follow-up. Of these, 29 reintegrated the cohort study after delivery. No association between HPV and pregnancy was found. A single SIL case (high grade SIL) occurred post-partum. Likewise, there was no association between pregnancy and risk of low grade SIL or any-grade SIL at the next visit (adjusted OR = 0.84, 95 % CI: 0.46-15.33) after controlling for confounders. CONCLUSIONS No associations were found between pregnancy and HPV or LSIL. The single observed case of HSIL post-partum was more than would be expected based on the rate of these abnormalities among non-pregnant women. As this association was found with only one case, caution is required in the interpretation of these results.
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Affiliation(s)
- Helen Trottier
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada. .,Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada. .,Sainte-Justine Hospital Research Center, Department of Social and Preventive Medicine, Université de Montréal, 3175 Côte Sainte-Catherine, Room A-830, Montreal, QC, H3T 1C5, Canada.
| | - Marie-Hélène Mayrand
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada. .,Department of Obstetrics and Gynecology, Université de Montréal and CRCHUM, Montreal, Canada.
| | | | - Lenice Galan
- Ludwig Institute for Cancer Research, São Paulo, Brazil.
| | - Alex Ferenczy
- Department of Pathology, McGill University and Jewish General Hospital, Montreal, Canada.
| | - Luisa L Villa
- Ludwig Institute for Cancer Research, São Paulo, Brazil. .,Department of Radiology and Oncology, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Eduardo L Franco
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada.
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Papoutsis D, Underwood M, Parry-Smith W, Panikkar J. Risk factors for treatment failure following cold coagulation cervical treatment for CIN pathology: a cohort-based study. Arch Gynecol Obstet 2015; 292:1329-37. [DOI: 10.1007/s00404-015-3761-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/13/2015] [Indexed: 01/08/2023]
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Coffey K, Beral V, Green J, Reeves G, Barnes I. Lifestyle and reproductive risk factors associated with anal cancer in women aged over 50 years. Br J Cancer 2015; 112:1568-74. [PMID: 25867258 PMCID: PMC4453684 DOI: 10.1038/bjc.2015.89] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/03/2015] [Accepted: 02/07/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Anal cancer incidence increases with age and is higher in women than men. Risk factors in this group other than high-risk human papillomavirus infection are unclear. METHODS In all, 1.3 million women were recruited in 1996-2001 and followed for incident anal cancer. Cox regression models were used to calculate relative risks (RRs) for anal cancer by various potential risk factors. RESULTS Five hundred and seventeen incident anal cancers were registered over 13 years of follow-up. The largest RR was associated with a history of cervical intraepithelial neoplasia grade 3 (CIN 3; RR=4.03, 95% CI 2.59-6.28). Other factors associated with significantly increased risks in multivariate analyses were: ever smoking (RR=1.49, 1.24-1.80); previous use of oral contraceptives (RR=1.51, 1.24-1.83); nulliparity (RR=1.61, 1.24-2.07); tubal ligation (RR=1.39, 1.13-1.70) and not living with a partner (RR=1.82, 1.40-2.38). The association with smoking was significantly greater for squamous cell carcinoma than adenocarcinoma of the anus (RR 1.66 vs 0.89, P for heterogeneity=0.04). CONCLUSIONS History of CIN 3, smoking, past oral contraceptive use, nulliparity, tubal ligation and not living with a partner are risk factors for anal cancer in women. There was a significant increase in risk associated with smoking for squamous cell anal cancers but not adenocarcinomas.
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Affiliation(s)
- K Coffey
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - V Beral
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - J Green
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - G Reeves
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - I Barnes
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
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Abstract
Human papillomavirus associated uterine cervical cancer is an important public health problem since it is classified as the fourth most common cancer in women worldwide with more than 500,000 recorded cases. This review is focused on where and why HPV infection induces cervical cancers and how this virus avoids the host immune response. Immunological therapeutic approaches are also addressed.
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Affiliation(s)
- Dorien Van Hede
- University of Liège, cellular and molecular immunology, GIGA-Research, 4000 Liège, Belgium
| | - Inge Langers
- University of Liège, cellular and molecular immunology, GIGA-Research, 4000 Liège, Belgium
| | - Philippe Delvenne
- University of Liège, experimental pathology, GIGA-Research, 4000 Liège, Belgium
| | - Nathalie Jacobs
- University of Liège, cellular and molecular immunology, GIGA-Research, 4000 Liège, Belgium.
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17
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Balsat C, Signolle N, Goffin F, Delbecque K, Plancoulaine B, Sauthier P, Samouëlian V, Béliard A, Munaut C, Foidart JM, Blacher S, Noël A, Kridelka F. Improved computer-assisted analysis of the global lymphatic network in human cervical tissues. Mod Pathol 2014; 27:887-98. [PMID: 24309324 DOI: 10.1038/modpathol.2013.195] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 09/20/2013] [Accepted: 09/23/2013] [Indexed: 11/08/2022]
Abstract
Lymphatic dissemination is a key event in cervical cancer progression and related tumor lymphatic markers are viewed as promising prognostic factor of nodal extension. However, validating such parameters requires an objective characterization of the lymphatic vasculature. Here, we performed a global analysis of the lymphatic network using a new computerized method applied on whole uterine cervical digital images. Sixty-eight cases of cervical neoplasia (12 CIN3, 10 FIGO stage 1A and 46 stage IB1) and 10 cases of normal cervical tissue were reacted with antibodies raised against D2-40, D2-40/p16 and D2-40/Ki67. Immunostained structures were automatically detected on whole slides. The lymphatic vessel density (D2-40), proliferating lymphatic vessel density (D2-40/ki67) and spatial lymphatic distribution in respect to the adjacent epithelium were assessed from normal cervix to early cervical cancer and correlated with lymphovascular space invasion and lymph node status. Prominent lymphatic vessel density and proliferating lymphatic vessel density are detected under the transformation zone of benign cervix and no further increase is noted during cancer progression. Notably, a shift of lymphatic vessel distribution toward the neoplastic edges is detected. In IB1 cervical cancer, although intra- and peritumoral lymphatic vessel density are neither correlated with lymphovascular space invasion nor with lymph node metastasis, a specific spatial distribution with more lymphatic vessels in the vicinity of tumor edges is predictive of lymphatic dissemination. Herein, we provide a new computerized method suitable for an innovative detailed analysis of the lymphatic network. We show that the transformation zone of the benign cervix acts as a baseline lymphangiogenic niche before the initiation of neoplastic process. During cancer progression, this specific microenvironment is maintained with lymphatic vessels even in closer vicinity to tumor cells.
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Herfs M, Vargas SO, Yamamoto Y, Howitt BE, Nucci MR, Hornick JL, McKeon FD, Xian W, Crum CP. A novel blueprint for 'top down' differentiation defines the cervical squamocolumnar junction during development, reproductive life, and neoplasia. J Pathol 2013; 229:460-8. [PMID: 23007879 DOI: 10.1002/path.4110] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 08/17/2012] [Accepted: 09/13/2012] [Indexed: 02/05/2023]
Abstract
The cervical squamocolumnar (SC) junction is the site of a recently discovered 'embryonic' cell population that was proposed as the cell of origin for cervical cancer and its precursors. How this population participates in cervical remodelling and neoplasia is unclear. In the present study, we analysed the SC junction immunophenotype during pre- and post-natal human and mouse development and in the adult, processes of metaplastic evolution of the SC junction, microglandular change, and early cervical neoplasia. Early in life, embryonic cervical epithelial cells were seen throughout the cervix and subsequently diminished in number to become concentrated at the SC junction in the adult. In all settings, there was a repetitive scenario in which cuboidal embryonic/SC junction cells gave rise to subjacent metaplastic basal/reserve cells with a switch from the SC junction positive to negative immunophenotype. This downward or basal (rather than upward or apical) evolution from progenitor cell to metaplastic progeny was termed reverse or 'top down' differentiation. A similar pattern was noted in high-grade squamous intraepithelial lesions (HSILs), suggesting that HPV infection of the cuboidal SC junction cells initiated outgrowth of basally-oriented neoplastic progeny. The progressive loss of the embryonic/SC junction markers occurred with 'top down' differentiation during development, remodelling, and early neoplasia. Interestingly, most low-grade SILs were SC junction-negative, implying infection of metaplastic progeny rather than the original SC junction cells. This proposed model of 'top down' differentiation resolves the mystery of how SC junction cells both remodel the cervix and participate in neoplasia and provides for a second population of metaplastic progeny (including basal and reserve cells), the infection of which is paradoxically less likely to produce a biologically aggressive precursor. It also provides new targets in animal models to determine why the SC junction is uniquely susceptible to carcinogenic HPV infection.
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Affiliation(s)
- Michael Herfs
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA
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Natphopsuk S, Settheetham-Ishida W, Sinawat S, Pientong C, Yuenyao P, Ishida T. Risk Factors for Cervical Cancer in Northeastern Thailand: Detailed Analyses of Sexual and Smoking Behavior. Asian Pac J Cancer Prev 2012; 13:5489-95. [DOI: 10.7314/apjcp.2012.13.11.5489] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Jensen KE, Schmiedel S, Norrild B, Frederiksen K, Iftner T, Kjaer SK. Parity as a cofactor for high-grade cervical disease among women with persistent human papillomavirus infection: a 13-year follow-up. Br J Cancer 2013; 108:234-9. [PMID: 23169283 DOI: 10.1038/bjc.2012.513] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Several environmental factors have been associated with increased risks for cervical cancer. We examined whether reproductive history, contraceptive use, or sexual behaviour increase the risk for cervical intraepithelial neoplasia grade 3 or worse (CIN3+) among women with persistent human papillomavirus (HPV) infection. Methods: A population-based cohort of women participated in a personal interview and underwent a gynaecological examination at which cervical specimens were obtained for HPV DNA testing. Follow-up information (∼13 years) on cervical lesions was obtained from the Danish Pathology Data Bank. Women who had a high-risk HPV infection comprised the overall study population (n=1353). A subgroup of women with persistent high-risk HPV infection (n=312) was identified. Hazard ratios (HRs) for a diagnosis of CIN3+ and the corresponding 95% confidence intervals (CIs) were calculated. Results: Women with persistent HPV infection who had given birth had a significantly increased risk for CIN3+ (HR=1.78; 95% CI: 1.07–2.94). No association was found with pregnancy, use of intrauterine devices, or sexual behaviour. Based on small numbers, women with persistent HPV infection had a decreased risk for CIN3+ with any use of oral contraceptives (HR=0.54; 95% CI: 0.29–1.00). Conclusion: Childbirth increases the risk for subsequent CIN3+ among women with persistent HPV infection.
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Abstract
This chapter reviews the findings from epidemiologic studies of the associations of physical activity with gynecologic cancers, including those of the endometrium, ovaries, and cervix, and the biologic mechanisms mediating the associations. The epidemiologic evidence to date suggests that physical activity probably protects against endometrial cancer, with a risk reduction of about 20-30% for those with the highest levels of physical activity compared to those with the lowest levels, and that light to moderate physical activity including housework, gardening, or walking for transportation may reduce risk. The role of physical activity in ovarian cancer development remains uncertain, as findings from these studies have been inconsistent with about half the studies suggesting physical activity modestly decreases risk and about half the studies suggesting no association. A recent meta-analysis of studies examining recreational physical activity with ovarian cancer risk estimated a 20% reduced risk for the most active versus least active women. There is mounting evidence that sedentary behaviors such as sitting time probably increase risk of endometrial and ovarian cancers. Overall, there is insufficient evidence to draw a conclusion on a possible role of physical activity in the development of cervical cancer, although a modest influence on risk is possible through effects on sex steroid hormones and immune function. The biologic evidence provides strong support for a protective role of physical activity on cancer of the endometrium, and moderate support for cancer of the ovaries, as these cancers have a strong hormonal etiology. The more established biologic mechanisms that are supported by epidemiologic and experimental data involve endogenous sex hormone levels, insulin-mediated pathways, and maintenance of energy balance.In this chapter, we will discuss the evidence for an association of physical activity with gynecologic cancers including those of the endometrium, ovaries, and cervix. Cancers of the endometrium and ovaries have a strong hormonal etiology (Risch 1998; Kaaks et al. 2002; Lukanova and Kaaks 2005), and physical activity has been postulated as a potential modifiable risk factor for prevention of these cancers because it can influence circulating hormone levels, energy balance, and insulin-mediated pathways that are thought to be important mediators underlying the associations. Few studies have evaluated the association of physical activity with cervical cancer because the main causal factor is infection with certain types of human papillomavirus (HPV), although other hormonal and immune factors are also thought to play a role (Smith et al. 2003; Waggoner 2003). We review the findings from epidemiologic studies that have examined the associations of physical activity with gynecologic cancers, and the biologic mechanisms that might mediate the associations.
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Affiliation(s)
- Anne E Cust
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, The University of Melbourne, Level 1, 723 Swanston Street, Melbourne, VIC, 3010, Australia.
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Louvanto K, Syrjänen KJ, Rintala MA, Grénman SE, Syrjänen SM. Human papillomavirus and predictors of cervical intraepithelial neoplasia among young mothers in a prospective follow-up study. Acta Obstet Gynecol Scand 2010; 90:167-73. [PMID: 21241262 DOI: 10.1111/j.1600-0412.2010.01029.x] [Citation(s) in RCA: 6] [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] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study the incidence times and rates for cervical intraepithelial neoplasia (CIN) and its predictors. MATERIAL AND METHODS This is a prospective follow-up study at Turku University Hospital, Finland. The Finnish Family human papillomavirus (HPV) study comprised 329 pregnant women followed up for 3 years. In an extension of the follow-up period, 171 women participated in an additional 3 years follow-up. Cervical scrapings for HPV testing and cervical smears were collected at each follow-up visit (2, 12, 24 and 36 months and 6 years). Following two abnormal cervical smears, colposcopy with biopsies was done. The main outcome measures were actuarial and crude incidence times, incidence rates and predictors of incident CIN. RESULTS During the follow-up period, 10 women (3.2%) developed biopsy-confirmed CIN, and four presented with incident atypical squamous cells suggesting high-grade squamous intraepithelial lesion cytology. The CIN/squamous intraepithelial lesion developed in 74.5 and 66.3 months, with crude incidence rates of 13.4/1,000 and 15.1/1,000 women months at risk, respectively. In multivariate Poisson regression, independent predictors of incident CIN were as follows: high-risk HPV positive at baseline (incidence rate ratio = 5.54; 95% confidence interval 1.02-30.14, p= 0.048); type-specific high-risk HPV persistence during follow-up (incidence rate ratio = 5.84; 95% confidence interval 2.28-17.93, p= 0.0001); cervical smear cytologically diagnosed for atypical squamous cells of undetermined significance or worse at any follow-up visit (incidence rate ratio = 4.56; 95% confidence interval 2.37-8.78, p= 0.0001); and new sexual partner during follow-up (incidence rate ratio = 9.45; 95% confidence interval 1.90-46.97, p= 0.006). CONCLUSION The results indicate that combined use of cervical smear and HPV testing, with prompt referral to colposcopy, enables accurate detection of incident CIN well before progression to invasive cancer. In addition to baseline and persistent high-risk HPV, abnormal cervical smear and new sexual partner are key predictors of incident CIN.
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Affiliation(s)
- Karolina Louvanto
- Medicity Research Laboratory and Department of Oral Pathology, Institute of Dentistry, Faculty of Medicine, University of Turku, Finland.
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Colegrove KM, Gullanda FMD, Naydan DK, Lowenstine LJ. Tumor Morphology and Immunohistochemical Expression of Estrogen Receptor, Progesterone Receptor, p53, and Ki67 in Urogenital Carcinomas of California Sea Lions (Zalophus californianus). Vet Pathol 2009; 46:642-55. [DOI: 10.1354/vp.08-vp-0214-c-fl] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Metastatic carcinoma of urogenital origin is a common cause of mortality in free-ranging California sea lions (Zalophus californianus). The etiology of this cancer is likely multifactorial, with viral infection, genetic factors, and exposure to environmental organochlorine contaminants possible contributing factors. In this study, expression of estrogen receptor α (ER α), progesterone receptor (PR), p53, and Ki67 were evaluated by immunohistochemistry in 12 sea lions with metastatic carcinoma, genital epithelial dysplasia, and intraepithelial neoplasia; 4 with genital epithelial dysplasia and intraepithelial neoplasia without metastases; and 6 control animals. Dysplastic and neoplastic lesions were identified in multiple areas of the cervix, vagina, penis, prepuce, and urethra in affected animals, suggesting multicentric development. Lesions were graded according to degree of epithelial dysplasia and infiltration and lesions of different grades were evaluated separately. Estrogen receptor expression was lower in intraepithelial lesions compared with normal genital epithelium, and expression in metastatic lesions was completely absent. There was progesterone receptor expression in neoplastic cells in intraepithelial lesions of all grades and in metastases, with no significant difference between lesion grades or between control and affected epithelium. Ki67 index and p53 expression increased with lesion grade and were higher in lesions than normal epithelium. Metastatic tumors exhibited highly variable morphology; however, proliferation index, ER α, PR, and p53 expression were similar in tumors with different patterns of growth. These results suggest that endogenous hormones, environmental contaminants that interact with steroid hormone receptors, and alterations in p53 may play a role in urogenital carcinogenesis in California sea lions.
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Affiliation(s)
- K. M. Colegrove
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis
| | | | - D. K. Naydan
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA
| | - L. J. Lowenstine
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis
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Zhu X, Lv J, Yu L, Zhu X, Wu J, Zou S, Jiang S. Proteomic identification of differentially-expressed proteins in squamous cervical cancer. Gynecol Oncol 2009; 112:248-56. [DOI: 10.1016/j.ygyno.2008.09.045] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 09/20/2008] [Accepted: 09/27/2008] [Indexed: 10/21/2022]
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Chlebowski RT, Prentice R. Tibolone in older postmenopausal women. N Engl J Med 2008; 359:2172-3; author reply 2173. [PMID: 19005202 DOI: 10.1056/nejmc081934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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