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Seifert F, Eisenblätter R, Beckmann J, Schürmann P, Hanel P, Jentschke M, Böhmer G, Strauß HG, Hirchenhain C, Schmidmayr M, Müller F, Fasching P, Luyten A, Häfner N, Dürst M, Runnebaum IB, Hillemanns P, Dörk T, Ramachandran D. Association of two genomic variants with HPV type-specific risk of cervical cancer. Tumour Virus Res 2023; 16:200269. [PMID: 37499979 PMCID: PMC10415783 DOI: 10.1016/j.tvr.2023.200269] [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: 05/12/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023] Open
Abstract
PROBLEM Human papillomavirus infection is integral to developing invasive cervical cancer in the majority of patients. In a recent genome-wide association study, rs9357152 and rs4243652 have been associated with seropositivity for HPV16 or HPV18, respectively. It is unknown whether these variants also associate with cervical cancer triggered by either HPV16 or HPV18. METHODS We investigate whether the two HPV susceptibility variants show association with type-specific cervical cancer in a genetic case-control study with cases stratified by HPV16 or HPV18, respectively. We further tested whether rs9357152 modulates gene expression of any of 36 genes at the human leukocyte antigen locus in 256 cervical tissues. RESULTS rs9357152 was associated with invasive HPV16-positive cervical cancer (OR 1.33, 95%CI 1.03-1.70, p = 0.03), and rs4243652 was associated with HPV18-positive adenocarcinomas (OR 2.96, 95%CI 1.18-7.41, p = 0.02). These associations remained borderline significant after testing against different sets of controls. rs9357152 was found to be an eQTL for HLA-DRB1 in HPV-positive cervical tissues (pANOVA = 0.0009), with the risk allele lowering mRNA levels. CONCLUSIONS We find evidence that HPV seropositivity variants at chromosome 6 and 14 may modulate type-specific cervical cancer risk. rs9357152 may exert its effect through regulating HLA-DRB1 induction in the presence of HPV. In regard of multiple testing, these results need to be confirmed in larger studies.
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Affiliation(s)
- Finja Seifert
- Gynaecology Research Unit, Comprehensive Cancer Center, Hannover Medical School, D-30625, Hannover, Germany
| | - Rieke Eisenblätter
- Gynaecology Research Unit, Comprehensive Cancer Center, Hannover Medical School, D-30625, Hannover, Germany
| | - Julia Beckmann
- Gynaecology Research Unit, Comprehensive Cancer Center, Hannover Medical School, D-30625, Hannover, Germany
| | - Peter Schürmann
- Gynaecology Research Unit, Comprehensive Cancer Center, Hannover Medical School, D-30625, Hannover, Germany
| | - Patricia Hanel
- Gynaecology Research Unit, Comprehensive Cancer Center, Hannover Medical School, D-30625, Hannover, Germany
| | - Matthias Jentschke
- Clinics of Gynaecology and Obstetrics, Hannover Medical School, D-30625, Hannover, Germany
| | | | - Hans-Georg Strauß
- Department of Gynaecology, University Clinics, Martin-Luther University, Halle-Wittenberg, Germany
| | - Christine Hirchenhain
- Department of Gynaecology, Clinics Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - Monika Schmidmayr
- Department of Gynaecology, Technische Universität München, Munich, Germany
| | - Florian Müller
- Martin-Luther Hospital, Charite University, Berlin, Germany
| | - Peter Fasching
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Luyten
- Dysplasia Unit, Department of Gynaecology and Obstetrics, Mare Klinikum, Kronshagen, Germany; Department of Gynaecology, Wolfsburg Hospital, Wolfsburg, Germany
| | - Norman Häfner
- Department of Gynaecology, Jena University Hospital, Friedrich -Schiller-University Jena, Jena, Germany
| | - Matthias Dürst
- Department of Gynaecology, Jena University Hospital, Friedrich -Schiller-University Jena, Jena, Germany
| | - Ingo B Runnebaum
- Department of Gynaecology, Jena University Hospital, Friedrich -Schiller-University Jena, Jena, Germany
| | - Peter Hillemanns
- Clinics of Gynaecology and Obstetrics, Hannover Medical School, D-30625, Hannover, Germany
| | - Thilo Dörk
- Gynaecology Research Unit, Comprehensive Cancer Center, Hannover Medical School, D-30625, Hannover, Germany
| | - Dhanya Ramachandran
- Gynaecology Research Unit, Comprehensive Cancer Center, Hannover Medical School, D-30625, Hannover, Germany.
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Henes M, Mann E, Hirchenhain C, Bauer E, Kentner A, Quaas J, Koßagk C, Gallwas J, Henes L, Schumacher A, Küppers V. Registry Study of the Working Group on Cervical Pathology and Colposcopy (AGCPC) on the Diagnostic Algorithm for the New Cervical Cancer Screening - Initial Data. Geburtshilfe Frauenheilkd 2023; 83:1250-1262. [PMID: 37808262 PMCID: PMC10556876 DOI: 10.1055/a-2159-7510] [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: 07/11/2023] [Accepted: 08/19/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction For the first time since 1971, new regulations were introduced for cervical cancer screening as an organized cancer screening guideline (oKFE-RL) starting 1 January 2020. From the age of 20, a cytological smear test is performed annually, and from the age of 35, so-called co-testing (cytology and test for high-risk HPVs) is performed every three years. In case of abnormalities, the algorithm is used as the basis for investigation. According to this diagnostic algorithm, even so-called low-risk groups receive early colposcopic evaluation. This approach has been heavily debated and serves as the basis for this registry study. Methods All patients who presented to the centers for a colposcopy as part of the diagnostic algorithm were included after signing an informed consent form. The following findings were obtained: Medical history, colposcopy, histology, and cytology findings, as well as possible therapies and their findings. The aim was to evaluate the frequency of the target lesions cervical intraepithelial neoplasia (CIN) 2+/CIN 3+ in the respective groups. Result A total of 4763 patients were enrolled in the study from July 2020 to October 2022. As a referral diagnosis, HPV persistence (HPV: human papillomavirus) with group I was determined in 23.9% (1139), HPV persistence with group II-a in 2.1% (100), II-p (ASC-US) in 11.2% (535), and II-g (AGC endocervical NOS) in 1.3% (64). III-p (ASC-H) and III-g (AGC endocervical favor neoplastic) were found in 9.4% (447) and 2.2% (107), respectively, IIID1 (LSIL) in 19% (906), IIID2 (HSIL, moderate dysplasia) in 18.9% (898), IVa-p (HSIL, severe dysplasia) in 10.7% (508), IVa-g (AIS) in 0.7% (31), IVb-p (HSIL with features suspicious for invasion) and IVb-g (AIS with features suspicious for invasion) in 0.3% (15), 0.1% (6), and 7 with suspected invasion V-p (squamous cell carcinoma)/V-g (endocervical adenocarcinoma) (0.1%). In the IVa-p group (HSIL, severe dysplasia), 67.7% had CIN 2+ and 56.5% had CIN 3+, adenocarcinoma in situ (AIS), and adenocarcinoma. If the histology of the excised tissue specifically based on the colposcope findings was also evaluated, CIN 2+ was found in 79.7% of cases, and CIN 3+ in 67.3% of cases. In IIID2 (HSIL, moderate dysplasia), CIN 2+ was detected in 50.9%, and CIN 3+/AIS in 28.3%. After evaluating patients who underwent surgery immediately, this increased to 53.0% for CIN 2+ and 29.3% for CIN 3+/AIS. In IIID1 (LSIL), CIN 2+ was detected in 27.4% and CIN 3+/AIS in 11.7%, and in II-p (ASC-US), CIN 2+ was detected in 23.4% and CIN 3+ and AIS in 10.8%, and in II-g (AGC endocervical NOS), CIN 2+ was detected in 34.4% and CIN 3+ in 23.4%. In the HPV persistence/II-a and I group, 21% showed CIN 2+, and 12.1% showed CIN 3+ and AIS, and 13% showed CIN 2+ and 5.9% showed CIN 3+ and AIS. In patients who were HPV-negative and had further diagnostics performed on the basis of cytologic smear alone, 27.9% had CIN 2+, and 14.1% had CIN 3 and AIS. Discussion In a synopsis of the present findings of our initial data of the registry study on the new cervical cancer screening, according to the organized early cancer screening guideline (oKFE-RL), we could show that the target lesion CIN 3+ and AIS is detected unexpectedly frequently in a not insignificant proportion, especially in the cytological low-risk group. Currently, we cannot answer whether this can reduce the incidence and mortality of cervical carcinoma, but this could be an initial indication of this and will be reviewed in further long-term evaluations.
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Affiliation(s)
- Melanie Henes
- Department für Frauengesundheit Tübingen, Universitätsfrauenklinik, Tübingen, Germany
| | - Ellen Mann
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany
| | - Christine Hirchenhain
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Emanuel Bauer
- amedes MVZ für Gynäkologie und Pathologie München, München, Germany
| | | | - Jens Quaas
- Facharztpraxis für Frauenheilkunde und Geburtshilfe, Hansestadt Stralsund, Germany
| | - Christopher Koßagk
- Gynäkologisches Versorgungszentrum Kreuzberg MVZ/Köpenick, Berlin, Germany
| | - Julia Gallwas
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Germany
| | - Leon Henes
- Department für Frauengesundheit Tübingen, Universitätsfrauenklinik, Tübingen, Germany
| | - Antonia Schumacher
- Department für Frauengesundheit Tübingen, Universitätsfrauenklinik, Tübingen, Germany
| | - Volkmar Küppers
- Zytologisches Labor, Facharztpraxis für Frauenheilkunde und Geburtshilfe, Düsseldorf, Germany
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Hoyer H, Stolte C, Böhmer G, Hampl M, Hagemann I, Maier E, Denecke A, Hirchenhain C, Patzke J, Jentschke M, Gerick A, Heller T, Hippe J, Wunsch K, Schmitz M, Dürst M. Evaluation of CIN2/3 Lesion Regression in GynTect ® DNA Methylation-Marker-Negative Patients in a Longitudinal Study. Cancers (Basel) 2023; 15:3951. [PMID: 37568767 PMCID: PMC10417134 DOI: 10.3390/cancers15153951] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Cervical intraepithelial neoplasia (CIN) grade 2/3 has a high spontaneous regression rate, especially among women ≤29 years of age. To reduce overtreatment, reliable prognostic biomarkers would be helpful. The main aim of this study was to analyze the negative predictive value of the methylation marker panel GynTect® for lesion regression. In this prospective, multicenter, longitudinal observational proof-of-concept study, women aged ≤29 years with histologically confirmed CIN2 (n = 24) or CIN3 (n = 36) were closely monitored without treatment for up to 24 or 12 months, respectively. The outcome was either regression, persistence, or progression of the lesion. For each patient, a single baseline sample (V0) for cytology, hrHPV detection and methylation analysis was taken. In a primary analysis, the negative predictive value (NPV) of a GynTect®-negative test result at V0 for regression was determined. We tested the null hypothesis NPV ≤ 70% against the alternative hypothesis NPV ≥ 90%. Twelve of the eighteen GynTect®-negative CIN2 patients showed regression (NPV = 67%, 90% CI 44-85%, p = 0.53). Of the 27 GynTect®-negative CIN3 lesions, 15 regressed (NPV = 56%, 90% CI 38-72%, p = 0.92). Although the majority of GynTect®-negative lesions regressed, the postulated NPV of ≥90% was not observed. Thus, the clinical relevance for an implementation of the GynTect® assay for patients undergoing watchful waiting remains questionable. Further studies with longer observation periods should be undertaken.
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Affiliation(s)
- Heike Hoyer
- Institut für Medizinische Statistik, Informatik und Datenwissenschaften, Universitätsklinikum Jena, 07743 Jena, Germany;
| | - Claudia Stolte
- Institut für Zytologie und Dysplasie (IZD), 30159 Hannover, Germany; (C.S.); (G.B.)
| | - Gerd Böhmer
- Institut für Zytologie und Dysplasie (IZD), 30159 Hannover, Germany; (C.S.); (G.B.)
| | - Monika Hampl
- Frauenklinik, Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany;
| | - Ingke Hagemann
- Abts+Partner Partnerschaftsgesellschaft, 24103 Kiel, Germany;
| | | | | | - Christine Hirchenhain
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Technische Universität Dresden, 01307 Dresden, Germany;
| | | | - Matthias Jentschke
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover (MHH), 30625 Hannover, Germany;
| | - Axel Gerick
- Praxis Dr. Axel Gerick, 52072 Aachen, Germany;
| | - Tabitha Heller
- Zentrum für Klinische Studien (ZKS), Universitätsklinikum Jena, 07747 Jena, Germany;
| | - Juliane Hippe
- Ongnostics GmbH, 07749 Jena, Germany; (J.H.); (K.W.); (M.S.)
| | - Kristina Wunsch
- Ongnostics GmbH, 07749 Jena, Germany; (J.H.); (K.W.); (M.S.)
| | - Martina Schmitz
- Ongnostics GmbH, 07749 Jena, Germany; (J.H.); (K.W.); (M.S.)
| | - Matthias Dürst
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, 07747 Jena, Germany
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4
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Balint N, David M, Fegert JM, Fryszer LA, Helling-Bakki A, Herrmann B, Hirchenhain C, Schmidt U, Winter SM. Statement of the DGGG - Recommendations on the Care and Support of Female Minors Suspected of Having Been Subjected to Acute Sexual Violence or Rape. Geburtshilfe Frauenheilkd 2022; 82:694-705. [PMID: 35815100 PMCID: PMC9262634 DOI: 10.1055/a-1860-0562] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/22/2022] [Indexed: 11/07/2022] Open
Abstract
Ziele
Die vorgelegten Empfehlungen sollen zur weiteren Verbesserung und Standardisierung der ärztlichen Versorgung von Betroffenen sexualisierter Gewalt, insbes. von einer
Vergewaltigung betroffenen weiblichen Minderjährigen in Deutschland beitragen. Sie wendet sich vor allem an Frauenärztinnen und Frauenärzte in der Klinik und in der Niederlassung und ergänzt
die umfangreiche Kinderschutzleitlinie der Bundesrepublik Deutschland.
Methoden
Unter Einbeziehung der Ergebnisse einer umfassenden selektiven Literaturrecherche wurden von einer interdisziplinär besetzten Gruppe von Expertinnen und Experten in einem
3-stufigen Verfahren im Auftrag des Vorstands der DGGG diese Empfehlungen erarbeitet und im Konsens verabschiedet.
Zusammenfassung
Diese DGGG-Stellungnahme ist entsprechend dem Alter der Betroffenen (ca. 14 bis 17 Jahre/pubertär; 0 bis ca. 13 Jahre/präpubertär) zweigeteilt. Dies hat medizinische,
strukturelle und forensische Gründe. Es werden zahlreiche Empfehlungen zum Umgang mit den mutmaßlich von akuter sexualisierter Gewalt bzw. einer Vergewaltigung betroffenen Minderjährigen,
zur Erstversorgung, zu Versorgungsformen (z. B. Vertrauliche Spurensicherung), zur Anamneseerhebung, zur medizinisch-forensischen Untersuchung, zur medizinischen, psychischen und
psychosozialen Versorgung sowie zur Nachbetreuung gegeben.
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Affiliation(s)
- Nicole Balint
- Klinik für Gynäkologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias David
- Klinik für Gynäkologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jörg M Fegert
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm, Ulm, Germany
| | - Lina Ana Fryszer
- Klinik für Gynäkologie mit Brustzentrum, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Astrid Helling-Bakki
- World Childhood Foundation (Deutschland), Stiftung für hilfsbedürftige Kinder, Geschäftsführung, Stuttgart, Germany
| | - Bernd Herrmann
- Ärztliche Kinderschutzambulanz, Klinik für Neonatologie und allgemeine Pädiatrie, Klinikum Kassel, Kassel, Germany
| | - Christine Hirchenhain
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Ulrike Schmidt
- Institut für Rechtsmedizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Sibylle Maria Winter
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Childhood-Haus Berlin, Berlin, Germany
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5
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Ramachandran D, Dennis J, Fachal L, Schürmann P, Bousset K, Hülse F, Mao Q, Wang Y, Jentschke M, Böhmer G, Strauß HG, Hirchenhain C, Schmidmayr M, Müller F, Runnebaum I, Hein A, Stübs F, Koch M, Ruebner M, Beckmann MW, Fasching PA, Luyten A, Dürst M, Hillemanns P, Easton DF, Dörk T. OUP accepted manuscript. Hum Mol Genet 2022; 31:2483-2497. [PMID: 35157032 PMCID: PMC9396939 DOI: 10.1093/hmg/ddac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Dhanya Ramachandran
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Laura Fachal
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Peter Schürmann
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Kristine Bousset
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Fabienne Hülse
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Qianqian Mao
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Yingying Wang
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Matthias Jentschke
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | | | - Hans-Georg Strauß
- Department of Gynaecology, University Clinics, Martin-Luther University, Halle-Wittenberg, Germany
| | - Christine Hirchenhain
- Department of Gynaecology, Clinics Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - Monika Schmidmayr
- Department of Gynaecology, Technische Universität München, Munich, Germany
| | - Florian Müller
- Martin-Luther Hospital, Charite University, Berlin, Germany
| | - Ingo Runnebaum
- Department of Gynaecology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena 07747, Germany
| | - Alexander Hein
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Frederik Stübs
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Martin Koch
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Matthias Ruebner
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Matthias W Beckmann
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Peter A Fasching
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Alexander Luyten
- Dysplasia Unit, Department of Gynaecology and Obstetrics, Mare Klinikum, Kronshagen, Germany
- Department of Gynaecology, Wolfsburg Hospital, Wolfsburg, Germany
| | - Matthias Dürst
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Peter Hillemanns
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Thilo Dörk
- To whom correspondence should be addressed at: Gynaecology Research Unit (OE6411), Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Tel: +49 5115326075; Fax: +49 5115326081;
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6
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Ramachandran D, Wang Y, Schürmann P, Hülse F, Mao Q, Jentschke M, Böhmer G, Strauß HG, Hirchenhain C, Schmidmayr M, Müller F, Runnebaum I, Hein A, Koch M, Ruebner M, Beckmann MW, Fasching PA, Luyten A, Dürst M, Hillemanns P, Dörk T. Association of genomic variants at PAX8 and PBX2 with cervical cancer risk. Int J Cancer 2021; 149:893-900. [PMID: 33905146 DOI: 10.1002/ijc.33614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/19/2021] [Accepted: 03/31/2021] [Indexed: 12/15/2022]
Abstract
Cervical malignancy is triggered by human papillomavirus infection but the risk for cervical cancer has a hereditary component. From a recent Genome Wide Association Study meta-analysis, 2q14.1 (PAX8) and 6p21.32 (PBX2) have been proposed as novel cervical cancer susceptibility loci. We investigated the two main signals at these loci in an independent case-control series of 2578 cases with cervical dysplasia or carcinoma and 1483 healthy females. We find significant associations for both variants, rs10175462 at PAX8 and rs2856437 at PBX2, with overall cervical disease (rs10175462: odds ratio [OR] 0.82, 95% confidence interval [CI] 0.74-0.91, P = 2.4 × 10-4 ; rs2856437: OR 1.52, 95% CI 1.14-2.02, P = .004). Both variants showed evidence of association with invasive squamous cervical cancer (rs10175462: OR 0.80, 95% CI 0.68-0.94, P = .006; rs2856437: OR 1.56, 95% CI 1.03-2.36, P = .036) and with high-grade dysplasia (rs10175462: OR 0.79, 95%CI 0.70-0.90, P = 1.9 × 10-4 ; rs2856437: OR 1.58, 95% CI 1.15-2.17, P = .005). A combined analysis of high-grade dysplasia and invasive cervical cancer also showed significant associations for both variants (rs10175462: OR 0.81, 95% CI 0.73-0.91, P = 2.4 × 10-4 ; rs2856437: OR 1.57, 95% CI 1.18-2.10, P = .002). No association was detected for rs2856437 with low-grade dysplasia, while rs10175462 showed weak evidence of association (P = .05). RNA analyses in cervical samples revealed that PAX8 transcripts were upregulated in HPV-positive lesions (P = .008) but this was not observed in the presence of the protective minor allele of rs10175462. The rs10175462 genotype also correlated with reduced levels of the lncRNA PAX8-AS1 (P < .001). Taken together, our results extend the evidence for a link between genomic risk variants at the HLA region (PBX2) with cervical disease and support PAX8 as the first consistent non-HLA cervical cancer susceptibility locus.
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Affiliation(s)
- Dhanya Ramachandran
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Yingying Wang
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Peter Schürmann
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Fabienne Hülse
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Qianqian Mao
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Matthias Jentschke
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | | | - Hans-Georg Strauß
- Department of Gynaecology, University Clinics, Martin-Luther University, Halle-Wittenberg, Germany
| | - Christine Hirchenhain
- Department of Gynaecology, Clinics Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - Monika Schmidmayr
- Department of Gynaecology, Technische Universität München, Munich, Germany
| | - Florian Müller
- Martin-Luther Hospital, Charite University, Berlin, Germany
| | - Ingo Runnebaum
- Department of Gynecology, Jena University Hospital, Friedrich -Schiller-University Jena, Jena, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Martin Koch
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Alexander Luyten
- Dysplasia Unit, Department of Gynecology and Obstetrics, Mare Klinikum, Kronshagen, Germany
- Department of Gynecology, Wolfsburg Hospital, Wolfsburg, Germany
| | - Matthias Dürst
- Department of Gynecology, Jena University Hospital, Friedrich -Schiller-University Jena, Jena, Germany
| | - Peter Hillemanns
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Thilo Dörk
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
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Süß I, Wimberger P, Hirchenhain C. Dysplasien der Zervix uteri in der Schwangerschaft – eine retrospektive Analyse von Daten aus der Dysplasiesprechstunde. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- I. Süß
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe
| | - P. Wimberger
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe
| | - C. Hirchenhain
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe
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Ramachandran D, Schürmann P, Mao Q, Wang Y, Bretschneider LM, Speith LM, Hülse F, Enßen J, Bousset K, Jentschke M, Böhmer G, Strauß HG, Hirchenhain C, Schmidmayr M, Tarbiat J, Runnebaum I, Dürst M, Hein A, Koch M, Ruebner M, Ekici A, Beckmann MW, Fasching PA, Luyten A, Petry KU, Hillemanns P, Dörk T. Association of genomic variants at the human leukocyte antigen locus with cervical cancer risk, HPV status and gene expression levels. Int J Cancer 2020; 147:2458-2468. [PMID: 32580243 DOI: 10.1002/ijc.33171] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/15/2020] [Accepted: 05/25/2020] [Indexed: 12/17/2022]
Abstract
The human leukocyte antigen (HLA) locus on chromosome 6 has been reported to be associated with cervical cancer. We investigated two independent single-nucleotide polymorphisms in a large case-control series of cervical dysplasia and carcinoma that has been newly established by the German Cervigen Consortium, comprising a total of 2481 cases and 1556 healthy females. We find significant associations for both variants, rs9272117 at HLA-DQA1 and rs2844511 at MICA and HCP5, with cervical disease. Both variants showed evidence of association with invasive cervical cancer (rs9272117: OR 0.89, 95% CI 0.79-0.99, P = .036; rs2844511: OR 1.17, 95% CI 1.04-1.31, P = .008) and with high-grade dysplasia (rs9272117: OR 0.78, 95% CI 0.70-0.87, P = 7.1 × 10-6 ; rs2844511: OR 1.13, 95% CI 1.01-1.26, P = .035), as well as in a combined analysis of both groups (rs9272117: OR 0.83, 95% CI 0.75-0.91, P = 6.9 × 10-5 ; rs2844511: OR 1.14, 95% CI 1.04-1.26, P = .005). Variant rs2844511, but not rs9272117, also showed modest evidence of association with low-grade dysplasia (OR 1.26, 95% CI 1.04-1.54, P = .019). In case-only analyses, rs2844511 tended to predict HPV status (P = .044) and rs9272117 tended to associate with HPV16 (P = .022). RNA studies in cervical samples showed a significant correlation in the transcript levels of MICA, HCP5 and HLA-DQA1, suggesting extensive co-regulation. All three genes were upregulated in HPV16-positive samples. In stratified analyses, rs9272117 was associated with HLA-DQA1 levels, specifically in HPV-positive samples, while rs2844511 was associated with MICA and HCP5 levels. The risk allele of rs2844511 was required for correlations between MICA or HCP5 with HLA-DQA1. Altogether, our results support 6p21.32-33 as the first consistent cervical cancer susceptibility locus and provide evidence for a link between genetic risk variants, HPV16 status and transcript levels of HLA-DQA1, HCP5 and MICA, which may contribute to tumor immune evasion.
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Affiliation(s)
- Dhanya Ramachandran
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Peter Schürmann
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Qianqian Mao
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Yingying Wang
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Lisa-Marie Bretschneider
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Lisa-Marie Speith
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Fabienne Hülse
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Julia Enßen
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Kristine Bousset
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Matthias Jentschke
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | | | - Hans-Georg Strauß
- Department of Gynaecology, University Clinics, Martin-Luther University, Halle-Wittenberg, Germany
| | - Christine Hirchenhain
- Department of Gynaecology, Clinics Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - Monika Schmidmayr
- Department of Gynaecology, Technische Universität München, Munich, Germany
| | | | - Ingo Runnebaum
- Department of Gynecology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matthias Dürst
- Department of Gynecology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Martin Koch
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Arif Ekici
- Institute of Human Genetics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Alexander Luyten
- Dysplasia Unit, Department of Gynecology and Obstetrics, Mare Klinikum, Kronshagen, Germany.,Department of Gynecology, Wolfsburg Hospital, Wolfsburg, Germany
| | | | - Peter Hillemanns
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Thilo Dörk
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
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Hausold J, Hirchenhain C, Wimberger P. Lichen sclerosus im Kindes- und Jugendalter – oft unerkannt und falsch therapiert. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- J Hausold
- Universitätsklinik Dresden, Frauenklinik, Dresden, Deutschland
| | - C Hirchenhain
- Universitätsklinik Dresden, Frauenklinik, Dresden, Deutschland
| | - P Wimberger
- Universitätsklinik Dresden, Frauenklinik, Dresden, Deutschland
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Gabrys M, Wimberger P, Hirchenhain C. AIS – Adenokarzinoma in situ der Zervix uteri. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- M Gabrys
- Universitätsfrauenklinik Dresden, Dresden, Deutschland
| | - P Wimberger
- Universitätsfrauenklinik Dresden, Dresden, Deutschland
| | - C Hirchenhain
- Universitätsfrauenklinik Dresden, Dresden, Deutschland
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Gabrys M, Wimberger P, Hirchenhain C. AIS – Adenokarzinoma in situ der Zervix uteri. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1645901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- M Gabrys
- Universitätsfrauenklinik Dresden
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12
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Hausold J, Wimberger P, Hirchenhain C. Lichen sclerosus im Kindes- und Jugendalter – oft unerkannt und falsch therapiert. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1645905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- J Hausold
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe der Technischen Universität Dresden
| | - P Wimberger
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe der Technischen Universität Dresden
| | - C Hirchenhain
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe der Technischen Universität Dresden
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13
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Zimmermann J, Hirchenhain C, Wimberger P. Ulcus acutum vulvae (Lipschütz) – eine seltene Manifestation eines Genitalulcus. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Zimmermann J, Hirchenhain C, Wimberger P. Ulcus acutum vulvae (Lipschütz) – eine seltene Entität eines Genitalulcus. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1583575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Hirchenhain C, Petzold A. Zervixdysplasie bei einer 14-jährigen Patientin – eine Falldarstellung. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1551614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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16
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Zimmermann J, Hirchenhain C. Lichen sclerosus – eine seltene, häufig falsch therapierte Erkrankung (Neue S3-Leitlinien der Europäischen Gesellschaft für Dermatologie). Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1551637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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17
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Rosner A, Lachmann R, Hirchenhain C, Porcelijn L, Kamin G, Hölig K. Versorgung einer Zweitschwangerschaft nach fetaler/neonataler Alloimmunthrombozytopenie (FNAIT) von HPA-1a-heterozygotem Vater. Transfusionsmedizin 2013. [DOI: 10.1055/s-0032-1325065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A. Rosner
- Bereich Transfusionsmedizin, Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden
| | - R. Lachmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus, Dresden
| | - C. Hirchenhain
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus, Dresden
| | - L. Porcelijn
- Platelet/Leukocyte Serology Laboratory/Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - G. Kamin
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus, Dresden
| | - K. Hölig
- Bereich Transfusionsmedizin, Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden
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