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Garland SM, Brotherton JML, Moscicki AB, Kaufmann AM, Stanley M, Bhatla N, Sankaranarayanan R, de Sanjosé S, Palefsky JM. HPV vaccination of immunocompromised hosts. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2017; 4:35-38. [PMID: 29179867 PMCID: PMC5883202 DOI: 10.1016/j.pvr.2017.06.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/02/2017] [Accepted: 06/02/2017] [Indexed: 01/04/2023]
Abstract
It is well-established that immunocompromised people are at increased risk of HPV-related disease compared with those who are immunocompetent. Prophylactic HPV sub-unit vaccines are safe and immunogenic in immunocompromised people and it is strongly recommended that vaccination occur according to national guidelines. When delivered to immunocompromised populations, HPV vaccines should be given as a 3-dose regimen.
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Affiliation(s)
- S M Garland
- Department of Microbiology and Infectious Diseases, Royal Women's Hospital, 30 Flemington Road, Parkville 3052, Australia; Murdoch Childrens Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Australia.
| | - J M L Brotherton
- VCS Registries, Victorian Cytology Service, Level 6, 176 Wellington Parade, East Melbourne 3002, Australia; School of Population and Global Health, University of Melbourne, Parkville 3052, Australia.
| | - A B Moscicki
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave. MDCC 22-432, MC:175217, Los Angeles, CA 90095, United States.
| | - A M Kaufmann
- Gynäkologische Tumorimmunologie, R. 4503 Gynäkologie, Charite-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
| | - M Stanley
- Department of Pathology, Tennis Court Road, Cambridge CB2 1QP, United Kingdom.
| | - N Bhatla
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - R Sankaranarayanan
- Screening Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France.
| | - S de Sanjosé
- Cancer Epidemiology Research Programme, IDIBELL, CIBERESP, Institut Català d'Oncologia, Av. Gran Via de l'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Spain.
| | - J M Palefsky
- University of California, San Francisco, 513 Parnassus Ave Box 0654, San Francisco, CA 94143, United States.
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Wilson LF, Antonsson A, Green AC, Jordan SJ, Kendall BJ, Nagle CM, Neale RE, Olsen CM, Webb PM, Whiteman DC. How many cancer cases and deaths are potentially preventable? Estimates for Australia in 2013. Int J Cancer 2017; 142:691-701. [DOI: 10.1002/ijc.31088] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Louise F. Wilson
- Population Health Department; QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston; QLD Australia
| | - Annika Antonsson
- Population Health Department; QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston; QLD Australia
- Faculty of Medicine, Herston Road; The University of Queensland; Herston QLD Australia
| | - Adele C. Green
- Population Health Department; QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston; QLD Australia
- Faculty of Medicine, Herston Road; The University of Queensland; Herston QLD Australia
- Cancer Research UK Manchester Institute and Institute of Inflammation and Repair, University of Manchester; Manchester United Kingdom
| | - Susan J. Jordan
- Population Health Department; QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston; QLD Australia
- Faculty of Medicine, Herston Road; The University of Queensland; Herston QLD Australia
| | - Bradley J. Kendall
- Population Health Department; QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston; QLD Australia
- Faculty of Medicine, Herston Road; The University of Queensland; Herston QLD Australia
- Department of Gastroenterology and Hepatology; Princess Alexandra Hospital; Brisbane QLD Australia
| | - Christina M. Nagle
- Population Health Department; QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston; QLD Australia
- Faculty of Medicine, Herston Road; The University of Queensland; Herston QLD Australia
| | - Rachel E. Neale
- Population Health Department; QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston; QLD Australia
- Faculty of Medicine, Herston Road; The University of Queensland; Herston QLD Australia
| | - Catherine M. Olsen
- Population Health Department; QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston; QLD Australia
- Faculty of Medicine, Herston Road; The University of Queensland; Herston QLD Australia
| | - Penelope M. Webb
- Population Health Department; QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston; QLD Australia
- Faculty of Medicine, Herston Road; The University of Queensland; Herston QLD Australia
| | - David C. Whiteman
- Population Health Department; QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston; QLD Australia
- Faculty of Medicine, Herston Road; The University of Queensland; Herston QLD Australia
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153
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Mena M, Lloveras B, Tous S, Bogers J, Maffini F, Gangane N, Kumar RV, Somanathan T, Lucas E, Anantharaman D, Gheit T, Castellsagué X, Pawlita M, de Sanjosé S, Alemany L, Tommasino M. Development and validation of a protocol for optimizing the use of paraffin blocks in molecular epidemiological studies: The example from the HPV-AHEAD study. PLoS One 2017; 12:e0184520. [PMID: 29036167 PMCID: PMC5642890 DOI: 10.1371/journal.pone.0184520] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/27/2017] [Indexed: 12/11/2022] Open
Abstract
Worldwide use of formalin-fixed paraffin-embedded blocks (FFPE) is extensive in diagnosis and research. Yet, there is a lack of optimized/standardized protocols to process the blocks and verify the quality and presence of the targeted tissue. In the context of an international study on head and neck cancer (HNC)-HPV-AHEAD, a standardized protocol for optimizing the use of FFPEs in molecular epidemiology was developed and validated. First, a protocol for sectioning the FFPE was developed to prevent cross-contamination and distributed between participating centers. Before processing blocks, all sectioning centers underwent a quality control to guarantee a satisfactory training process. The first and last sections of the FFPEs were used for histopathological assessment. A consensus histopathology evaluation form was developed by an international panel of pathologists and evaluated for four indicators in a pilot analysis in order to validate it: 1) presence/type of tumor tissue, 2) identification of other tissue components that could affect the molecular diagnosis and 3) quality of the tissue. No HPV DNA was found in sections from empty FFPE generated in any histology laboratories of HPV-AHEAD consortium and all centers passed quality assurance for processing after quality control. The pilot analysis to validate the histopathology form included 355 HNC cases. The form was filled by six pathologists and each case was randomly assigned to two of them. Most samples (86%) were considered satisfactory. Presence of >50% of invasive carcinoma was observed in all sections of 66% of cases. Substantial necrosis (>50%) was present in <2% of samples. The concordance for the indicators targeted to validate the histopathology form was very high (kappa > 0.85) between first and last sections and fair to high between pathologists (kappa/pabak 0.21-0.72). The protocol allowed to correctly process without signs of contamination all FFPE of the study. The histopathology evaluation of the cases assured the presence of the targeted tissue, identified the presence of other tissues that could disturb the molecular diagnosis and allowed the assessment of tissue quality.
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Affiliation(s)
- Marisa Mena
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER in primary and secondary prevention of viral induced cancers (CIBERONC), Madrid, Spain
| | - Belen Lloveras
- Department of Pathology. Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Sara Tous
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER in primary and secondary prevention of viral induced cancers (CIBERONC), Madrid, Spain
| | - Johannes Bogers
- Laboratory of cell biology and histology, University of Antwerp, Antwerp, Belgium
| | - Fausto Maffini
- Division of Pathology, European Institute of Oncology, Milan, Italy
| | - Nitin Gangane
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, India
| | | | | | - Eric Lucas
- International Agency for Research on Cancer, Lyon, France
| | - Devasena Anantharaman
- International Agency for Research on Cancer, Lyon, France
- Cancer Research Program, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, India
| | - Tarik Gheit
- International Agency for Research on Cancer, Lyon, France
| | - Xavier Castellsagué
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Michael Pawlita
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Silvia de Sanjosé
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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154
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Buttmann-Schweiger N, Deleré Y, Klug SJ, Kraywinkel K. Cancer incidence in Germany attributable to human papillomavirus in 2013. BMC Cancer 2017; 17:682. [PMID: 29037233 PMCID: PMC5644114 DOI: 10.1186/s12885-017-3678-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 10/08/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND It is estimated that a total of 120,000 new cancer cases in men and in women in more developed countries could be avoided if exposure to HPV was prevented. We used the nationwide pool of German population-based cancer registry data to estimate the burden of HPV-attributable cancer in this population for the year 2013. METHODS Incident cases of cervical cancer, squamous cell carcinoma of the anus, oropharynx (OP), as well as of the vulva, vagina and penis were classified as potentially HPV-associated and identified from the nationwide cancer registry data-pool. We calculated the incidence and proportions of cancer with potentially HPV-associated morphologies. Estimation of the HPV-attributable incidence was based on prevalence-estimates of viral DNA in tumor cells in the respective sites, as provided from the international literature. RESULTS From the overall 15,936 incident cases of anogenital and OP cancers in 2013, 6239 female and 1358 male cancer cases were estimated to be attributable to HPV. The majority of HPV-attributable cases were contributed by cervical cancer (70.9% of female cancers) and oropharyngeal cancer (46.9% of male cancers). CONCLUSIONS Even if most HPV-attributable cases were contributed by cervical cancer, anogenital cancer at sites other than the cervix, and oropharyngeal cancer substantially contribute to the burden of HPV-associated cancer. Our nationwide cancer registry data-analyses provide the baseline for long-term population-based monitoring of vaccination-effects on cancer incidence in Germany.
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Affiliation(s)
- Nina Buttmann-Schweiger
- Department of Epidemiology and Health Monitoring, Robert Koch-Institut, Berlin, Germany
- Cancer Epidemiology, University Cancer Center Dresden, University Hospital, Technische Universität Dresden, Dresden, Germany
- Robert Koch-Institut, Department of Epidemiology and Health Monitoring, German Centre for Cancer Registry Data, General Pape-Straße 62-68, 12101 Berlin, Germany
| | - Yvonne Deleré
- General practitioner, Rudower Str. 60, 12524 Berlin, Germany
| | - Stefanie J. Klug
- Cancer Epidemiology, University Cancer Center Dresden, University Hospital, Technische Universität Dresden, Dresden, Germany
- Epidemiology, Department for Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Klaus Kraywinkel
- Department of Epidemiology and Health Monitoring, Robert Koch-Institut, Berlin, Germany
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155
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Zhang Z, Zhang J, Xia N, Zhao Q. Expanded strain coverage for a highly successful public health tool: Prophylactic 9-valent human papillomavirus vaccine. Hum Vaccin Immunother 2017; 13:2280-2291. [PMID: 28699820 PMCID: PMC5647960 DOI: 10.1080/21645515.2017.1346755] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 05/31/2017] [Accepted: 06/21/2017] [Indexed: 12/21/2022] Open
Abstract
Human papillomavirus is considered the causative factor for cervical cancer, which accounts for approximately 5% of the global cancer burden and more than 600,000 new cases annually that are attributable to HPV infection worldwide. The first-generation prophylactic HPV vaccines, Gardasil® and Cervarix®, were licensed approximately a decade ago. Both vaccines contain the most prevalent high-risk types, HPV16 and 18, which are associated with 70% of cervical cancer. To further increase the type coverage, 5 additional oncogenic HPV types (31, 33, 45, 52 and 58) were added to the existing Gardasil-4 to develop a 9-valent HPV vaccine (9vHPV), Gardasil 9®, increasing the potential level of protection from ∼70% to ∼90%. The efficacy of the vaccine lies primarily in its ability to elicit type-specific and neutralizing antibodies to fend off the viral infection. Therefore, type-specific and neutralizing murine monoclonal antibodies (mAbs) were used to quantitate the antigenicity of the individual vaccine antigens and to measure the antibody levels in the serum samples from vaccinees in a type- and epitope-specific manner in a competitive immunoassay. Assays for 9vHPV are extended from the proven platform used for 4vHPV by developing and adding new mAbs against the additional types. In Phase III clinical trials, comparable safety profile and immunogenicity against the original 4 types were demonstrated for the 9vHPV vaccine, and these were comparable to the 4vHPV vaccine. The efficacy of the 9vHPV vaccine was established in trials with young women. Immunobridging for younger boys and girls was performed, and the results showed higher immunogenicity in the younger age group. In a subsequent clinical trial, the 2-dose regimen of the 9vHPV vaccine used among girls and boys aged 9-14 y showed non-inferior immunogenicity to the regular 3-dose regimen for young women (aged 16-26 years). Overall, the clinical data and cost-effectiveness analysis for the 9vHPV vaccine support its widespread use to maximize the impact of this important, life-saving vaccine.
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Affiliation(s)
- Zhigang Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, PR China
| | - Jun Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, PR China
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, PR China
- School of Life Science, Xiamen University, Xiamen, Fujian, PR China
| | - Qinjian Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, PR China
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156
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Pils S, Gensthaler L, Alemany L, Horvat R, de Sanjosé S, Joura EA. HPV prevalence in vulvar cancer in Austria. Wien Klin Wochenschr 2017; 129:805-809. [PMID: 28884278 PMCID: PMC5676822 DOI: 10.1007/s00508-017-1255-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/15/2017] [Indexed: 11/30/2022]
Abstract
Background Even if vulvar cancer is not common, over one hundred women are affected in Austria per year. There is strong evidence that basaloid and warty variants are associated with types of human papillomavirus (HPV). Methods The aim of this study is to analyze the types of HPV in vulvar cancer in Austria. This cross-sectional period-prevalence international collaborative study on archival specimens was performed in cooperation with the Institut Catalan di Oncologia in Barcelona, Spain. A total of 177 consecutive samples of Austrian women were analyzed to detect the presence of various HPV types using the SPF10 PCR/DEIA/LiPA25 system. Furthermore, the expression of the tumor suppressor protein p16INK4a was analyzed by immunohistochemistry (CINtec histology kit, ROCHE). A tumor was considered HPV-driven if an overexpression of p16INK4a was detected. Results In all, 41 cases of vulvar cancer tested positive for HPV DNA (23%) and 32 (18%) were p16 positive. Patients with warty and basaloid squamous cell cancer were significantly younger than those with keratinizing squamous cell cancer (63.3 years vs. 71.0 years, p = 0.021). In addition, 77.4% of all cases suffering from warty or basaloid squamous cell cancer tested positive for HPV, compared to 9.5% of the keratinizing squamous cell cancer cases (p < 0.001). The most commonly detected HPV strain was type 16, followed by 31 and 33. Conclusion Infection with HPV type 16 appears to be strongly correlated to the development of warty or basaloid squamous cell cancer. Vaccination against HPV can be expected to prevent this type of vulvar cancer.
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Affiliation(s)
- Sophie Pils
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Lisa Gensthaler
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Laia Alemany
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Reinhard Horvat
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Silvia de Sanjosé
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elmar A Joura
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.
- Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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157
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Qendri V, Bogaards JA, Berkhof J. Health and Economic Impact of a Tender-Based, Sex-Neutral Human Papillomavirus 16/18 Vaccination Program in the Netherlands. J Infect Dis 2017; 216:210-219. [PMID: 28586466 DOI: 10.1093/infdis/jix272] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/02/2017] [Indexed: 12/27/2022] Open
Abstract
Background Uptake of human papillomavirus (HPV) vaccine among girls in the Dutch immunization program has plateaued at around 60%. Vaccinating boys may be an appealing complementary strategy for the prevention of HPV-related diseases, especially since tender negotiations and reduced dosing schemes have driven down the cost of vaccination. Methods We expanded a previously published Bayesian synthesis framework to account for all vaccine type-related cancers and herd immunity effects from vaccinating girls and boys. We evaluated the efficiency of vaccinating boys relative to increasing vaccine uptake among girls and assessed the cost-effectiveness of a sex-neutral program. Results Vaccinating 40% of boys along with 60% of girls yielded the same gain in life-years (LYs) as increasing the uptake in girls from 60% to 80%. The incremental cost-effectiveness ratio (ICER) of vaccinating boys was €9134/LY (95% credible interval [CrI], €7323/LY-€11231/LY) under 3% discounting. The ceiling vaccination costs at which the ICER remained below the per capita gross domestic product threshold was €240 (95% CrI, €200-€280) per vaccinated boy. If girls' uptake increased to 90%, the ceiling costs decreased to €70 (95% CrI, €40-€100) per vaccinated boy. Conclusions Vaccinating boys along with girls is only modestly less efficient than increasing uptake among girls and highly likely to be cost-effective under current vaccine costs and uptake in the Netherlands.
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Affiliation(s)
- Venetia Qendri
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam
| | - Johannes A Bogaards
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam.,Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam
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158
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Serrano B, Brotons M, Bosch FX, Bruni L. Epidemiology and burden of HPV-related disease. Best Pract Res Clin Obstet Gynaecol 2017; 47:14-26. [PMID: 29037457 DOI: 10.1016/j.bpobgyn.2017.08.006] [Citation(s) in RCA: 271] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 08/24/2017] [Accepted: 08/24/2017] [Indexed: 12/29/2022]
Abstract
Human papillomavirus (HPV) infection is recognized as one of the major causes of infection-related cancer in both men and women. High-risk HPV types are not only responsible for virtually all cervical cancer cases but also for a fraction of cancers of the vulva, vagina, penis, anus, and head and neck cancers. Furthermore, HPV is also the cause of anogenital warts and recurrent respiratory papillomatosis. Despite the availability of multiple preventative strategies, HPV-related cancer remains a leading cause of morbi-mortality in many parts of the world, particularly in less developed countries. Thus, in this review, we summarize the latest estimates of the global burden of HPV-related diseases, trends, the attributable fraction by HPV types, and the potential preventative fraction.
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Affiliation(s)
- Beatriz Serrano
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme (CERP), Institut Català d'Oncologia (ICO) - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Barcelona, Spain.
| | - María Brotons
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme (CERP), Institut Català d'Oncologia (ICO) - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Barcelona, Spain.
| | - Francesc Xavier Bosch
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme (CERP), Institut Català d'Oncologia (ICO) - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Barcelona, Spain.
| | - Laia Bruni
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme (CERP), Institut Català d'Oncologia (ICO) - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Barcelona, Spain.
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159
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Donà MG, Rollo F, Pichi B, Spriano G, Pellini R, Covello R, Pescarmona E, Fabbri G, Scalfari M, Gheit T, Benevolo M. Evaluation of the Xpert® HPV assay in the detection of Human Papillomavirus in formalin-fixed paraffin-embedded oropharyngeal carcinomas. Oral Oncol 2017; 72:117-122. [PMID: 28797447 DOI: 10.1016/j.oraloncology.2017.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/26/2017] [Accepted: 07/14/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The increasing incidence of HPV-related Oropharyngeal Squamous Cell Carcinoma (OPSCC) and the improved survival of HPV-positive OPSCC highlight the need for effective tools in evaluating HPV status on formalin-fixed paraffin-embedded (FFPE) cancers. To date, there is no agreement regarding the most appropriate method for HPV testing on FFPE materials. We aimed to investigate the performance of the Xpert® HPV assay (Cepheid) on crude lysates from OPSCC FFPE tissues. MATERIALS AND METHODS Crude lysates were obtained by proteinase K digestion of FFPE tissues that had already been analyzed by the INNO-LiPA HPV assay and p16ink4a immunostaining. RESULTS 159 FFPE OPSCCs were evaluated. All the samples provided valid results with the Xpert, whereas three samples (1.8%) were invalid using the INNO-LiPA. Among the remaining 156 cases, 65 (41.7%) were concordantly positive and 87 (55.8%) concordantly negative (raw agreement 0.97, 95% CI: 0.93-0.99; Cohen K 0.95, 95% CI: 0.90-0.99). Type-specific data for the cases that were positive by both methods were completely concordant. Three samples were HPV16-positive with Xpert but negative with INNO-LiPA, while one OPSCC tested negative with Xpert and positive with INNO-LiPA. A very good agreement was observed between the Xpert and the p16 results, which was slightly higher than that for INNO-LiPA (Cohen K 0.87vs. 0.85). CONCLUSION The Xpert HPV assay appears to be a very good method for HPV detection and genotyping on FFPE OPSCCs, and requires no prior purification of nucleic acids. This assay showed a very good agreement with INNO-LiPA and p16 findings.
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Affiliation(s)
- Maria Gabriella Donà
- Sexually Transmitted Infection (STI) Unit, San Gallicano Dermatologic Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Francesca Rollo
- Pathology Department, Regina Elena National Cancer Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Barbara Pichi
- Otolaryngology Head Neck Surgery Department, Regina Elena National Cancer Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Giuseppe Spriano
- Otolaryngology Head Neck Surgery Department, Regina Elena National Cancer Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Raul Pellini
- Otolaryngology Head Neck Surgery Department, Regina Elena National Cancer Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Renato Covello
- Pathology Department, Regina Elena National Cancer Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Edoardo Pescarmona
- Pathology Department, Regina Elena National Cancer Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Giulia Fabbri
- Pathology Department, Regina Elena National Cancer Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Manuela Scalfari
- Pathology Department, Regina Elena National Cancer Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Tarik Gheit
- Infections and Cancer Biology Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon, France
| | - Maria Benevolo
- Pathology Department, Regina Elena National Cancer Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy.
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160
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Rakislova N, Clavero O, Alemany L, Saco A, Quirós B, Lloveras B, Alejo M, Pawlita M, Quint W, del Pino M, de Sanjose S, Ordi J. "Histological characteristics of HPV-associated and -independent squamous cell carcinomas of the vulva: A study of 1,594 cases”. Int J Cancer 2017; 141:2517-2527. [DOI: 10.1002/ijc.31006] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/03/2017] [Accepted: 08/07/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Natalia Rakislova
- Department of Pathology; ISGlobal, Hospital Clínic - Universitat de Barcelona; Barcelona Spain
| | - Omar Clavero
- Unit of Infections and Cancer; Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat; Barcelona Spain
| | - Laia Alemany
- Unit of Infections and Cancer; Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat; Barcelona Spain
- CIBER Epidemiologia y Salud Pública; Barcelona Spain
| | - Adela Saco
- Department of Pathology; ISGlobal, Hospital Clínic - Universitat de Barcelona; Barcelona Spain
| | - Beatriz Quirós
- Unit of Infections and Cancer; Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat; Barcelona Spain
| | - Belen Lloveras
- Department of Pathology; Hospital del Mar; Barcelona Spain
| | - Maria Alejo
- Department of Pathology; Hospital General d'Hospitalet, L'Hospitalet de LLobregat; Barcelona Spain
| | - Michael Pawlita
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infection, Inflammation and Cancer; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Wim Quint
- DDL Diagnostic Laboratory; Rijswijk The Netherlands
| | - Marta del Pino
- Faculty of Medicine, Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic - Institut d´Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona; Barcelona Spain
| | - Silvia de Sanjose
- Unit of Infections and Cancer; Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat; Barcelona Spain
- CIBER Epidemiologia y Salud Pública; Barcelona Spain
| | - Jaume Ordi
- Department of Pathology; ISGlobal, Hospital Clínic - Universitat de Barcelona; Barcelona Spain
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161
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Kang YJ, Smith M, Barlow E, Coffey K, Hacker N, Canfell K. Vulvar cancer in high-income countries: Increasing burden of disease. Int J Cancer 2017; 141:2174-2186. [PMID: 28730615 DOI: 10.1002/ijc.30900] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/16/2017] [Accepted: 06/28/2017] [Indexed: 11/10/2022]
Abstract
The aim of this study was to assess trends in the age-specific incidence of vulvar cancer in 13 high-income countries satisfying a priori conditions regarding the availability of cancer registry data over a 20-year period; these were Canada, the United States, nine European countries, Australia and Japan. Five-yearly incidence and population at risk were obtained from the International Agency for Research on Cancer's Cancer Incidence in Five Continents for the years 1988-1992 (Volume 7) to 2003-2007 (Volume 10). The 5-yearly average percent change (AvPC) over the period and standardised rate ratios (SRRs) for 2003-2007 versus 1988-1992 were used to assess changes in the age-standardised incidence rates of vulvar cancer for all ages, and for <60 years and 60+ years. During the study period, the 5-yearly AvPC across the 13 countries increased by 4.6% (p = 0.005) in women of all ages, and 11.6% (p = 0.02) in those <60 years. No change was observed in women aged 60+ years (5-yearly AvPC = 0.1%, p = 0.94). The SRR for 2003-2007 versus 1988-1992 was significantly elevated in women <60 years of age (SRR = 1.38, 95% CI: 1.30-1.46), but not in women of 60+ years (SRR = 1.01, 95% CI: 0.97-1.05). The increase in incidence in women <60 years of age drove a significant increase in the overall SRR in women of all ages (SRR = 1.14, 95% CI: 1.11-1.18). Some differences in the specific findings at the individual country level were observed. The findings are consistent with changing sexual behaviours and increasing levels of exposure to human papillomavirus (HPV) in cohorts born around/after about 1950, but younger cohorts offered HPV vaccination are likely to receive some protection against developing vulvar cancer in the future.
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Affiliation(s)
- Yoon-Jung Kang
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
| | - Megan Smith
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
| | - Ellen Barlow
- Gynaecological Cancer Centre, Royal Hospital for Women, Randwick, Sydney, NSW, Australia
| | - Kate Coffey
- Department of Women's Health, Dunedin Hospital, Dunedin, New Zealand
| | - Neville Hacker
- Gynaecological Cancer Centre, Royal Hospital for Women, Randwick, Sydney, NSW, Australia.,Department of Womens' and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia.,School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
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162
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Horn LC, Brambs CE, Handzel R, Mehlhorn G, Schmidt D, Schierle K. [Nomenclature of squamous cell precursor lesions of the lower female genital tract : Current aspects]. DER PATHOLOGE 2017; 37:526-533. [PMID: 27738814 DOI: 10.1007/s00292-016-0239-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The majority of precancerous lesions of the lower female genital tract (intraepithelial neoplasia, IN) are caused by human papillomavirus (HPV) infections resulting in cellular atypia and in turn an altered tissue architecture. Depending on the pathogenesis, a distinction is made between vulvar intraepithelial neoplasia (VIN) classified as classical VIN associated with high-risk HPV infections (u-VIN) and differentiated VIN (d-VIN), which is associated with lichen sclerosus et atrophicus and p53 alterations. In the current World Health Organization (WHO) classification a novel grading system for squamous cell precancerous lesions of the lower female genital tract has been proposed, differentiating low grade squamous intraepithelial lesions (L-SIL) including condyloma and HPV-associated alterations plus VIN 1, vaginal intraepithelial neoplasia (VaIN 1) and cervical intraepithelial neoplasia (CIN 1) from high grade squamous intraepithelial lesions (H-SIL) with VIN 2 and 3, VaIN 2 and 3 as well as CIN 2 and 3. The use of p16 immunohistochemistry can assist the differentiation. The new binary classification, however, contradicts the German cytological nomenclature (Munich nomenclature III), which differentiated three grades of dysplasia in order to avoid overtreatment of patients with moderate IN. The individual nomenclatures are compared to each other. It is recommended to report the grade of precancerous lesions in addition to the SIL classification of the WHO.
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Affiliation(s)
- L-C Horn
- Institut für Pathologie, Abteilung Mamma-, Gynäko- und Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland.
| | - C E Brambs
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München, Deutschland
| | - R Handzel
- Universitätsfrauenklinik Leipzig (Triersches Institut) im Zentrum für Frauen- und Kindermedizin, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - G Mehlhorn
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - D Schmidt
- Institut für Pathologie, Viersen, Deutschland
| | - K Schierle
- Institut für Pathologie, Abteilung Mamma-, Gynäko- und Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland
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163
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Papillomavirus genotyping on formaldehyde fixed paraffin-embedded tissues in vulvar intraepithelial neoplasia. Arch Gynecol Obstet 2017; 296:811-817. [PMID: 28795241 DOI: 10.1007/s00404-017-4472-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Few studies have described the epidemiology of human papillomavirus (HPV) in vulvar intraepithelial neoplasia (VIN). The aim of this study was to genotype HPV on formalin fixed paraffin-embedded tissues in VIN lesions. METHODS A 5-year retrospective study was conducted by including all patients attending the teaching hospital of Nice with a diagnosis of VIN between 1st January 2010 and 31st December 2014. For all patients, HPV genotyping was performed with the PapilloCheck® microarray kit, routinely used on cervical cytology samples, and optimized for formaldehyde fixed paraffin-embedded tissues in VIN. RESULTS Forty patients were included in the study: 39 patients had usual VIN and one presented with differentiated VIN. Among the 39 patients with usual VIN, the prevalence of HPV was 90% (35/39). Thirty-two patients had high grade VIN (82%) and seven low grade VIN (18%). In high grade VIN, the most represented HPV types were: HPV 16 (21/32 66%), HPV 56 (3/32 9%) and HPV 33 (2/32 6%). In low grade VIN, the most represented HPV types were: HPV 16 (4/7 57%) and HPV 6 (3/7 43%). Interestingly, 5/39 (13%) of patients diagnosed with usual VIN also had co-existing lichen sclerosus. CONCLUSIONS We have optimized a HPV genotyping technique, routinely used on cervical cytology samples, and on paraffin fixed embedded tissue showing VIN. Moreover, we have identified five patients with lichen sclerosus co-existing with usual VIN. This association has rarely been reported and proves that these two entities can coexist.
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164
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Clinician's Update on the Benign, Premalignant, and Malignant Skin Tumours of the Vulva: The Dermatologist's View. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2017; 2017:2414569. [PMID: 28812059 PMCID: PMC5547714 DOI: 10.1155/2017/2414569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/18/2017] [Indexed: 12/12/2022]
Abstract
Correct and rapid diagnosis of skin tumours often requires biopsy and histopathological examination to differentiate benign lesions such as seborrhoeic keratoses or melanocytic naevi from premalignant and malignant lesions such as malignant melanoma. Particularly, to the untrained eye, any benign skin tumour—pigmented or nonpigmented—is easily mistaken for a malignant lesion. Qualified clinical evaluation is paramount in order to reduce the frequency of unwarranted skin biopsies. Herein, the most common benign, premalignant, and malignant vulvar skin tumours are reviewed.
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165
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Sznurkowski JJ, Żawrocki A, Biernat W. Local immune response depends on p16INK4a status of primary tumor in vulvar squamous cell carcinoma. Oncotarget 2017; 8:46204-46210. [PMID: 28515351 PMCID: PMC5542260 DOI: 10.18632/oncotarget.17581] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/04/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The p16Ink4a is not a surrogate marker for high-risk human papilloma virus (HPV) genotypes but indicates better prognosis in vulvar squamous cell carcinoma patients. Our recent study confirmed substantial mismatch between p16Ink4a and high-risk HPV-status as well as revealed that p16Ink4a-overexpression itself is an independent prognostic factor for vulvar cancer. AIM To determine significance of the tumor infiltrating immune cells and p16Ink4a-status for better outcome of patients with vulvar cancer. METHODS Intraepithelial tumor infiltrating lymphocytes: CD8+, CD4+, FOXP3+, CD56+, tumor associated macrophages: CD68+, and GZB+ cells were calculated in 85 vulvar squamous cell carcinomas with previously defined p16Ink4a and high-risk HPV-status. Number of intraepithelial CD8+, CD4+, FOXP3+, CD56+, CD68+ and GZB+ cells were compared between tumors with different p16INK4a status and overlapping high-risk HPV-status separately. Survival analyses included the Kaplan-Meier method, log-rank test and Cox proportional hazards model. RESULTS p16Ink4a-negative tumors were more infiltrated by intraepithelial CD8+, CD4+ and GZB+ cells than p16Ink4a-positive tumors (p=0.032, p=0.016 and p=0.007 respectively). High-risk HPV-status did not correlate with the infiltration of immune cells. Median follow up was 89.20 months (range 1.7-189.5). High CD4+ and CD56+ indices were correlated with prognosis in p16Ink4a-positive cases (p=0.039 and p=0.013 respectively). Low CD68+ infiltrates were correlated with prognosis in p16Ink4a-negative cases (p=0.018). CONCLUSION p16Ink4a-status impacts local immune surveillance as represented by tumor infiltrating immune cells. Immunologic effects contributing to clinical outcome might depend on p16Ink4a-overexpression.
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Affiliation(s)
| | - Anton Żawrocki
- Department of Pathology, The Medical University, Gdańsk, Poland
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166
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Abstract
Human papillomavirus (HPV) is involved in one of the at least 2 pathways leading to vulvar squamous cell carcinoma (VSCC). Inactivation of p53 and retinoblastoma by the viral products E6 and E7 is involved in malignant transformation. The percentage of HPV-positive VSCCs ranges from 18% to 75%, depending on the geographical area. HPV-associated tumors affect relatively young women and arise from high-grade intraepithelial lesions, identical to other HPV-associated premalignant lesions of the anogenital tract. HPV-independent tumors tend to affect older women and usually arise in a background of inflammatory skin disorders and a subtle variant of in situ lesion called differentiated vulvar intraepithelial neoplasia. HPV-positive tumors tend to be of basaloid or warty types, whereas HPV-independent tumors tend to be of keratinizing type, but there is frequent overlap between histologic types. There is no conclusive evidence yet on the best strategy in terms of determining HPV attribution. HPV DNA detection is generally considered the gold standard although there is some concern about misclassification when using this technique alone. p16 immunostaining has shown to be an excellent surrogate marker of HPV infection. Positive results for both techniques are considered the best evidence for HPV-association. The prognostic role of HPV in VSCC is still contradictory, but increasing evidence suggests that HPV-associated tumors are less aggressive. Currently, there are no differences in treatment between HPV-associated and HPV-independent VSCC, but novel immunological strategies based on anti-HPV antigens are being evaluated in clinical trials.
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167
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Faber MT, Sand FL, Albieri V, Norrild B, Kjaer SK, Verdoodt F. Prevalence and type distribution of human papillomavirus in squamous cell carcinoma and intraepithelial neoplasia of the vulva. Int J Cancer 2017; 141:1161-1169. [DOI: 10.1002/ijc.30821] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 05/11/2017] [Accepted: 05/22/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Mette T. Faber
- Danish Cancer Society Research Center; Virus, Lifestyle and Genes; Copenhagen Denmark
| | - Freja L. Sand
- Danish Cancer Society Research Center; Virus, Lifestyle and Genes; Copenhagen Denmark
| | - Vanna Albieri
- Danish Cancer Society Research Center; Statistics and Pharmacoepidemiology; Copenhagen Denmark
| | - Bodil Norrild
- Department of Cellular and Molecular Medicine; University of Copenhagen; Copenhagen Denmark
| | - Susanne K. Kjaer
- Danish Cancer Society Research Center; Virus, Lifestyle and Genes; Copenhagen Denmark
- Department of Gynecology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Freija Verdoodt
- Danish Cancer Society Research Center; Virus, Lifestyle and Genes; Copenhagen Denmark
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168
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Vulvar carcinoma in Norway: A 50-year perspective on trends in incidence, treatment and survival. Gynecol Oncol 2017; 145:543-548. [DOI: 10.1016/j.ygyno.2017.03.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/28/2017] [Accepted: 03/10/2017] [Indexed: 12/18/2022]
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169
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Petersen LK, Restrepo J, Moreira ED, Iversen OE, Pitisuttithum P, Van Damme P, Joura EA, Olsson SE, Ferris D, Block S, Giuliano AR, Bosch X, Pils S, Cuzick J, Garland SM, Huh W, Kjaer SK, Bautista OM, Hyatt D, Maansson R, Moeller E, Qi H, Roberts C, Luxembourg A. Impact of baseline covariates on the immunogenicity of the 9-valent HPV vaccine - A combined analysis of five phase III clinical trials. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2017; 3:105-115. [PMID: 28720442 PMCID: PMC5883201 DOI: 10.1016/j.pvr.2017.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 02/02/2017] [Accepted: 03/13/2017] [Indexed: 12/04/2022]
Abstract
BACKGROUND The immunogenicity profile of the 9-valent HPV (9vHPV) vaccine was evaluated across five phase III clinical studies conducted in girls and boys 9-15 years of age and young women 16-26 years of age. The effect of baseline characteristics of subjects on vaccine-induced HPV antibody responses was assessed. METHODS Immunogenicity data from 11,304 subjects who received ≥1 dose of 9vHPV vaccine in five Phase III studies were analyzed. Vaccine was administered as a 3-dose regimen. HPV antibody titers were assessed 1 month after dose 3 using a competitive Luminex immunoassay and summarized as geometric mean titers (GMTs). Covariates examined were age, gender, race, region of residence, and HPV serostatus and PCR status at day 1. RESULTS GMTs to all 9 vaccine HPV types decreased with age at vaccination initiation, and were otherwise generally similar among the demographic subgroups defined by gender, race and region of residence. For all subgroups defined by race or region of residence, GMTs were higher in girls and boys than in young women. Vaccination of subjects who were seropositive at day 1 to a vaccine HPV type resulted in higher GMTs to that type, compared with those in subjects who were seronegative for that type at day 1. CONCLUSIONS 9vHPV vaccine immunogenicity was robust among subjects with differing baseline characteristics. It was generally comparable across subjects of different races and from different regions. Greater immunogenicity in girls and boys versus young women (the population used to establish 9vHPV vaccine efficacy in clinical studies) indicates that the anti-HPV responses generated by the vaccine in adolescents from all races or regions were sufficient to induce high-level protective efficacy. This immunogenicity profile supports a widespread 9vHPV vaccination program and early vaccination.
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Affiliation(s)
- Lone K Petersen
- Aarhus University Hospital, Department of Obstetrics and Gynecology, Aarhus, Denmark
| | - Jaime Restrepo
- Fundación Centro de Investigación Clínica CIC, Medellín, Colombia
| | - Edson D Moreira
- Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Bahia, Brazil
| | - Ole-Erik Iversen
- Department of Clinical Science, University of Bergen and Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | | | - Pierre Van Damme
- Center for the Evaluation of Vaccination, University of Antwerp, Antwerp, Belgium
| | - Elmar A Joura
- Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | | | - Daron Ferris
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, GA, USA
| | - Stan Block
- Kentucky Pediatric and Adult Research, Inc., Bardstown, KY, USA
| | | | | | - Sophie Pils
- Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - Jack Cuzick
- Wolfson Institute of Preventive Medicine, London, UK
| | - Suzanne M Garland
- Royal Women's Hospital, University of Melbourne and Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Warner Huh
- Division of Gynecologic Oncology, University of Alabama, Birmingham, USA
| | - Susanne K Kjaer
- Danish Cancer Society Research Center and Department of Gynecology, Rigshospitalet, Denmark
| | | | | | | | | | - Hong Qi
- Merck & Co., Inc., Kenilworth, NJ, USA
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170
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Hartwig S, St Guily JL, Dominiak-Felden G, Alemany L, de Sanjosé S. Estimation of the overall burden of cancers, precancerous lesions, and genital warts attributable to 9-valent HPV vaccine types in women and men in Europe. Infect Agent Cancer 2017; 12:19. [PMID: 28400857 PMCID: PMC5387299 DOI: 10.1186/s13027-017-0129-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/21/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In addition to cervical cancer, human papillomavirus (HPV) is responsible for a significant proportion of cancers and precancerous lesions of the vulva, vagina, anus, penis, head and neck, as well as genital warts. We estimated the annual number of new cases of these diseases attributable to 9-valent HPV vaccine types in women and men in Europe. METHODS The annual number of new cancers of the cervix, vulva, vagina, anus, penis, and selected head and neck sites in the population of the European Medicines Agency territory was estimated based on age-specific incidence rates extracted from Cancer Incidence in 5 Continents, Volume X and Eurostat population data for 2015. The annual number of new cancers attributable to 9-valent HPV vaccine types was estimated by applying the HPV attributable fraction from reference publications based on a large European multicenter study. For non-cervical cancers, HPV attributable fractions were based on oncogenically-active HPV infections only (i.e., detection of HPV DNA and either mRNA and/or p16 positivity). For precancerous lesions of the cervix, vulva, vagina, and anus, and for genital warts, previously published estimations were updated for the 2015 population. RESULTS The annual number of new cancers attributable to 9-valent HPV vaccine types was estimated at 47,992 (95% bound: 39,785-58,511). Cervical cancer showed the highest burden (31,130 cases), followed by head and neck cancer (6,786 cases), anal cancer (6,137 cases), vulvar cancer (1,466 cases), vaginal cancer (1,360 cases), and penile cancer (1,113 cases). About 81% were estimated to occur in women and 19% in men. The annual number of new precancerous lesions (CIN2+, VIN2/3, VaIN2/3, and AIN2/3) and genital warts attributable to 9-valent HPV vaccine types was estimated at 232,103 to 442,347 and 680,344 to 844,391, respectively. CONCLUSIONS The burden of cancers associated with 9-valent HPV vaccine types in Europe is substantial in both sexes. Head and neck cancers constitute a heavy burden, particularly in men. Overall, about 90% of HPV-related cancers, 80% of precancerous lesions, and 90% of genital warts are expected to be attributable to 9-valent HPV vaccine types each year, demonstrating the important preventive potential of the 9-valent HPV vaccine in Europe.
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Affiliation(s)
- Susanne Hartwig
- Department of Epidemiology, Sanofi Pasteur MSD, 162 avenue Jean Jaurès, Lyon, France
| | - Jean Lacau St Guily
- Department of Otolaryngology-Head and Neck Surgery, Tenon Hospital – Assistance Publique-Hopitaux de Paris (AP-HP) and Sorbonne University-Paris 6, Pierre-et-Marie Curie University Cancerology Institute, 4 rue de la Chine, 75020 Paris, France
| | | | - Laia Alemany
- Cancer Epidemiology Research Program, Institut Català d’Oncologia (ICO)-IDIBELL, L’Hospitalet de Llobregat, Catalonia Spain
| | - Silvia de Sanjosé
- Cancer Epidemiology Research Program, Institut Català d’Oncologia (ICO)-IDIBELL, L’Hospitalet de Llobregat, Catalonia Spain
- CIBER Epidemiologia y Salud Pública, Barcelona, Spain
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171
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The Natural History of Vulvar Intraepithelial Neoplasia, Differentiated Type: Evidence for Progression and Diagnostic Challenges. Int J Gynecol Pathol 2017; 35:574-584. [PMID: 26974999 DOI: 10.1097/pgp.0000000000000280] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Squamous cell carcinoma of the vulva (SCCV) develops through either human papillomavirus (HPV)-dependent or HPV-independent pathways. Approximately 60% of SCCV arise independently of HPV, commonly in a background of an inflammatory dermatosis, particularly lichen sclerosus. The likely direct precursor to most of these lesions is vulvar intraepithelial neoplasia (VIN), differentiated type (dVIN), although the evidence is largely circumstantial. There are few reports of progression to carcinoma, and the natural history of this pathway is not well understood. Nevertheless, dVIN is widely regarded as a potentially aggressive lesion. We identified dVIN adjacent to SCCV in 97 of 212 women (45.8%). Twenty-four of the 97 women (24.7%) had biopsies performed at least 6 mo before presentation with SCCV; slides for 47 biopsies from 21 women were available for review. dVIN was identified in 18 biopsies from 8 women (38.1%), which in 14 biopsies had been previously unrecognized. The subsequent cancer developed in the same region as the previous biopsy showing dVIN in 6 of the 8 women. The median interval between biopsy and invasive cancer was 43.5 mo (range, 8-102 mo). dVIN-associated SCCV was strongly associated with both lichen sclerosus, and HPV-negative status compared with usual type VIN (relative risk=38.35 (9.755-150.8) and 0.06485 (0.02764-0.1522), respectively). This study adds to the evidence linking dVIN with SCCV, and indicates that both clinical and histologic underrecognition contribute to the apparent rarity of dVIN as a solitary diagnosis. The morphologic spectrum of dVIN is likely to be wider than commonly appreciated; however, histologically defining the lower threshold is difficult and controversial.
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172
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Human papillomavirus 16 is an aetiological factor of scrotal cancer. Br J Cancer 2017; 116:1218-1222. [PMID: 28376081 PMCID: PMC5418448 DOI: 10.1038/bjc.2017.74] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/23/2017] [Accepted: 03/01/2017] [Indexed: 01/21/2023] Open
Abstract
Background: Squamous cell scrotal carcinoma (SCSC) is an infrequent skin cancer associated historically with occupational carcinogens. Human papillomavirus (HPV) DNA has been associated with SCSC but there is no definitive proof of its oncogenic role. Methods: Human papillomavirus-DNA and –E6*I mRNA were analysed in six invasive histologically typed SCSC. LCM-PCR was used to localise HPV DNA to tumour cells. P16INK4aand p53 expression were studied by immunohistochemistry. Results: In three warty or basaloid SCSC HPV16-DNA and E6*I-mRNA were detected. LCM-PCR confirmed HPV16 was in p16INK4a-positive malignant cells. However, of three usual-type SCSC, all were HPV-negative and two expressed p53 protein but not p16INK4a. Conclusions: Human papillomavirus 16 was present in tumour cells and oncogenically active in basaloid and warty SCSC, whereas usual SCSC was HPV-negative and showed immunostaining, suggesting p53 mutation. The dual pathways of oncogenesis and relation between histological type of SCSC and HPV are similar to that in penile cancers.
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173
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Biological relevance of human papillomaviruses in vulvar cancer. Mod Pathol 2017; 30:549-562. [PMID: 28059099 DOI: 10.1038/modpathol.2016.197] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/12/2016] [Accepted: 10/18/2016] [Indexed: 12/31/2022]
Abstract
The carcinogenic role of high-risk human papillomavirus (HR-HPV) types in the increasing subset of vulvar intraepithelial neoplasia and vulvar cancer in young women has been established. However, the actual number of vulvar cancer cases attributed to HPV is still imprecisely defined. In an attempt to provide a more precise definition of HPV-driven vulvar cancer, we performed HPV-type-specific E6*I mRNA analyses available for 20 HR-/possible HR (pHR)-HPV types, on tissue samples from 447 cases of vulvar cancer. HPV DNA genotyping was performed using SPF10-LiPA25 assay due to its high sensitivity in formalin-fixed paraffin-embedded tissues. Data on p16INK4a expression was available for comparative analysis via kappa statistics. The use of highly sensitive assays covering the detection of HPV mRNA in a broad spectrum of mucosal HPV types resulted in the detection of viral transcripts in 87% of HPV DNA+ vulvar cancers. Overall concordance between HPV mRNA+ and p16INK4a upregulation (strong, diffuse immunostaining in >25% of tumor cells) was 92% (K=0.625, 95% confidence interval (CI)=0.531-0.719). Among these cases, 83% were concordant pairs of HPV mRNA+ and p16INK4a+ and 9% were concordant pairs of HPV mRNA- and p16INK4a-. Our data confirm the biological role of HR-/pHR-HPV types in the great majority of HPV DNA+ vulvar cancers, resulting in an HPV-attributable fraction of at least 21% worldwide. Most HPV DNA+ vulvar cancers were associated with HPV16 (85%), but a causative role for other, less frequently occurring mucosal HPV types (HPV26, 66, 67, 68, 70 and 73) was also confirmed at the mRNA level for the first time. These findings should be taken into consideration for future screening options as HPV-associated vulvar preneoplastic lesions have increased in incidence in younger women and require different treatment than vulvar lesions that develop from rare autoimmune-related mechanisms in older women.
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174
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Singh N, Gilks CB. The changing landscape of gynaecological cancer diagnosis: implications for histopathological practice in the 21st century. Histopathology 2017; 70:56-69. [PMID: 27960241 DOI: 10.1111/his.13080] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The era of molecular medicine has led to dramatically improved understanding of the genetic events that give rise to different types of cancers. In the case of gynaecological malignancies, this has resulted in distinct shifts in how these tumours are diagnosed in routine surgical pathology practice, with an increased emphasis on accurate subtype diagnosis. This has happened across all sites in the gynaecological tract and for most cell types, but in ways that are site-specific and may appear to be subtle, as in most instances the diagnostic terminology has not changed. For example, the diagnosis of clear cell carcinoma of the ovary is still in use, but the diagnostic criteria and clinical implications are different in 2017 from what they were in 2000. As a result, there can be a failure to appreciate how important these changes are and the resulting necessity of incorporating them into our daily practice. In this review we will describe changes in diagnostic surgical pathology occasioned by improved understanding of molecular events during pathogenesis, for cancers of ovary/tube, endometrium, cervix and vulva, and highlight how current practice differs from that of only a few years ago.
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Affiliation(s)
- Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - C Blake Gilks
- Department of Anatomic Pathology, Vancouver General Hospital, Vancouver, BC, Canada
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175
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Brinton LA, Thistle JE, Liao LM, Trabert B. Epidemiology of vulvar neoplasia in the NIH-AARP Study. Gynecol Oncol 2017; 145:298-304. [PMID: 28236455 DOI: 10.1016/j.ygyno.2017.02.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To clarify risk factors for rare vulvar neoplasms. METHODS Within the NIH-AARP Study, among 201,469 women interviewed in 1995-1996 and followed for a mean of 13.8years, there were 370 diagnoses of incident vulvar neoplasms, including 170 invasive and 198 vulvar intraepithelial neoplasms grade 3 (VIN3). Hazard ratios (HR) and 95% confidence intervals (CI) were calculated via multivariate logistic regression for various demographic, reproductive and lifestyle factors, with separate consideration of relations according to invasiveness, histology and age at diagnosis. RESULTS Consistent with descriptive data, we found non-white women at lower risks of vulvar neoplasia than white women (HR=0.59, 95% CI 0.36-0.95). Significant risk factors for VIN3 included being divorced/separated (HR vs. currently married=1.77, 95% CI 1.24-2.51), a current cigarette smoker (3.88, 95% CI 2.64-5.72), a user of oral contraceptives (1.46, 95% CI 1.06-2.01), or a current user of menopausal hormones (1.73, 95% CI 1.24-2.41). Significant risk factors for invasive cancers were being obese (HR for BMI ≥30 vs. <25=1.62, 95% CI 1.10-2.40) or a current smoker (1.86, 95% CI 1.21-2.87). Cigarette smoking was a risk factor mainly for neoplasms shown in other investigations to be HPV-related, namely VIN3 and invasive squamous cell cancers (SCCs) occurring in the younger stratum of cases. In contrast, obesity was primarily associated with the development of invasive SCCs. CONCLUSIONS Our results support that vulvar neoplasia is a heterogeneous disease. VIN3 demonstrated risk factors consistent with an HPV-related etiology, while invasive cancers were additionally affected by obesity, suggesting that further attention should focus on the role of chronic inflammatory conditions.
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Affiliation(s)
- Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States.
| | - Jake E Thistle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States
| | - Linda M Liao
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States
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176
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McDonald SA, Qendri V, Berkhof J, de Melker HE, Bogaards JA. Disease burden of human papillomavirus infection in the Netherlands, 1989-2014: the gap between females and males is diminishing. Cancer Causes Control 2017; 28:203-214. [PMID: 28213874 DOI: 10.1007/s10552-017-0870-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/08/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE Besides cervical cancer, HPV infection is linked to a multitude of diseases in both males and females, suggesting that vaccination programmes should be re-evaluated, with a judicious assessment made of the disease burden stratified by sex, age, and genotype. Projections of burden into the near future are also needed to provide a benchmark for evaluating the impact of vaccination programmes, and to assess the need for scaling-up preventive measures. METHODS Using the disability-adjusted life-years (DALY) measure, we estimated the total HPV-associated disease burden in the Netherlands. Annual cancer registrations over the period 1989-2014 for all cancers with an aetiological link to HPV infection were retrieved, supplemented by incidence data on high-grade cervical intraepithelial neoplasia (CIN) and anogenital warts. RESULTS Over the recent period 2011-2014, the average annual HPV disease burden was 10,600 DALYs (95% credible interval (CrI):10,260-10,960) in females and 3,346 DALYs (95% CrI: 2,973-3,762) in males. Burden was dominated by cervical cancer, but its share amongst women decreased from 89% in 1989 to 77% in 2014. The male share of the total disease burden increased from 9.8% in 1989 to 26% in 2014. In 2023 (before the expected clinical impact from vaccinating girls), total burden is forecasted at 1.3-fold larger than in 2014. CONCLUSIONS The HPV-associated disease burden is higher than that reported for any other infectious disease in the Netherlands, with a larger burden observed in women than in men. The rapidly rising male share of the total burden underlines the prioritization of male HPV-related disease in prevention programmes.
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Affiliation(s)
- Scott A McDonald
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - Venetia Qendri
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, The Netherlands.,VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Johannes Berkhof
- VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Johannes A Bogaards
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, The Netherlands
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Laco J, Chmelařová M, Vošmiková H, Sieglová K, Bubancová I, Dundr P, Němejcová K, Michálek J, Čelakovský P, Mottl R, Sirák I, Vošmik M, Ryška A. SMARCB1/INI1-deficient sinonasal carcinoma shows methylation of RASSF1 gene: A clinicopathological, immunohistochemical and molecular genetic study of a recently described entity. Pathol Res Pract 2017; 213:133-142. [PMID: 28069272 DOI: 10.1016/j.prp.2016.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/02/2016] [Accepted: 10/21/2016] [Indexed: 02/06/2023]
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178
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Apalla Z, Nashan D, Weller RB, Castellsagué X. Skin Cancer: Epidemiology, Disease Burden, Pathophysiology, Diagnosis, and Therapeutic Approaches. Dermatol Ther (Heidelb) 2017; 7:5-19. [PMID: 28150105 PMCID: PMC5289116 DOI: 10.1007/s13555-016-0165-y] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Indexed: 12/26/2022] Open
Abstract
Skin cancer, including both melanoma and non-melanoma, is the most common type of malignancy in the Caucasian population. Firstly, we review the evidence for the observed increase in the incidence of skin cancer over recent decades, and investigate whether this is a true increase or an artefact of greater screening and over-diagnosis. Prevention strategies are also discussed. Secondly, we discuss the complexities and challenges encountered when diagnosing and developing treatment strategies for skin cancer. Key case studies are presented that highlight the practic challenges of choosing the most appropriate treatment for patients with skin cancer. Thirdly, we consider the potential risks and benefits of increased sun exposure. However, this is discussed in terms of the possibility that the avoidance of sun exposure in order to reduce the risk of skin cancer may be less important than the reduction in all-cause mortality as a result of the potential benefits of increased exposure to the sun. Finally, we consider common questions on human papillomavirus infection.
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Affiliation(s)
- Zoe Apalla
- First Department of Dermatology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Dorothée Nashan
- Teaching Hospital of the University of Münster, Münster, Germany
| | | | - Xavier Castellsagué
- Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Catalonia, Spain
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179
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Iwata S, Murata S, Rong Han S, Wakana A, Sawata M, Tanaka Y. Safety and Immunogenicity of a 9-Valent Human Papillomavirus Vaccine Administered to 9- to 15-Year-Old Japanese Girls. Jpn J Infect Dis 2017; 70:368-373. [DOI: 10.7883/yoken.jjid.2016.299] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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180
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The 2015 International Society for the Study of Vulvovaginal Disease (ISSVD) Terminology of Vulvar Squamous Intraepithelial Lesions. Obstet Gynecol 2016; 127:264-8. [PMID: 26942352 DOI: 10.1097/aog.0000000000001285] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The impact of terminology for vulvar intraepithelial lesions has been significant over the years, because it has affected diagnosis, treatment, and research. The introduction of the Lower Anogenital Squamous Terminology (LAST) in 2012 raised 2 concerns in relation to vulvar lesions: firstly, the absence of reference to "differentiated vulvar intraepithelial neoplasia" (differentiated VIN) could lead to its being overlooked by health care providers, despite its malignant potential. Secondly, including the term "low-grade squamous intraepithelial lesion" (LSIL) in LAST recreated the potential for overdiagnosis and overtreatment for benign, self-limiting lesions. MATERIALS AND METHODS The International Society for the Study of Vulvovaginal Disease (ISSVD) assigned the terminology committee the task of developing a terminology to take these issues into consideration. The committee reviewed the development of terminology for vulvar SILs with the previous 2 concerns in mind and reviewed several new terminology options. RESULTS The final version accepted by the ISSVD contains the following: 1) Low-grade SIL of the vulva or vulvar LSIL, encompassing flat condyloma or human papillomavirus effect. 2) High-grade SIL or vulvar HSIL (which was termed "vulvar intraepithelial neoplasia usual type" in the 2004 ISSVD terminology). 3) Vulvar intraepithelial neoplasia, differentiated type. CONCLUSION The advantage of the new terminology is that it includes all types of vulvar SILs, it provides a solution to the concerns in relation to the application of LAST to vulvar lesion, and it is in accordance with the World Health Organization classification as well as the LAST, creating unity among clinicians and pathologists.
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181
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Luxembourg A, Kjaer SK, Nygard M, Ellison MC, Group T, Marshall JB, Radley D, Saah A. Design of a long-term follow-up effectiveness, immunogenicity and safety study of women who received the 9-valent human papillomavirus vaccine. Contemp Clin Trials 2016; 52:54-61. [PMID: 27777126 DOI: 10.1016/j.cct.2016.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
Abstract
The 9-valent human papillomavirus (HPV) (9vHPV) vaccine targets four HPV types (6/11/16/18) also covered by the quadrivalent HPV (qHPV) vaccine and five additional types (31/33/45/52/58). Vaccine efficacy to prevent HPV infection and disease was established in a Phase III clinical study in women 16-26years of age. A long-term follow-up (LTFU) study has been initiated as an extension of the Phase III clinical study to assess effectiveness of the 9vHPV vaccine up to at least 14years after the start of vaccination. It includes participants from Denmark, Norway and Sweden and uses national health registries from these countries to assess incidence of cervical pre-cancers and cancers due to the 7 oncogenic types in the vaccine (HPV 16/18/31/33/45/52/58). Incidences will be compared to the estimated incidence rate in an unvaccinated cohort of similar age and risk level. This LTFU study uses a unique design: it is an extension of a Phase III clinical study and also has elements of an epidemiological study (i.e., endpoints based on standard clinical practice; surveillance using searches from health registries); it uses a control chart method to determine whether vaccine effectiveness may be waning. Control chart methods which were developed in industrial and manufacturing settings for process and production monitoring, can be used to monitor disease incidence in real-time and promptly detect a decrease in vaccine effectiveness. Experience from this innovative study design may be applicable to other medicinal products when long-term outcomes need to be assessed, there is no control group, or outcomes are rare.
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Affiliation(s)
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mari Nygard
- Department of Research, Cancer Registry of Norway, Oslo, Norway
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Siegel DA, Wilson R, Wilkinson EJ, Gargano JW, Watson M, Hernandez BY, Goodman MT, Lynch CF, Unger ER, Saraiya M. Evaluation of the Vulvar Cancer Histology Code Reported by Central Cancer Registries: Importance in Epidemiology. Arch Pathol Lab Med 2016; 141:139-143. [PMID: 27763794 DOI: 10.5858/arpa.2015-0422-oa] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -Knowing the subtype of vulvar cancer histology is important for estimating human papillomavirus-related cancer etiology. Surveillance of human papillomavirus-related vulvar cancers informs public health decisions related to vaccination against human papillomavirus. OBJECTIVE -To assess the accuracy of registry classifications of vulvar cancer and determine the histologic classification of cases reported as not otherwise specified. DESIGN -Pathology specimens were collected from Florida, Iowa, and Hawaii cancer registries. Registry diagnosis was compared with the pathology report from the medical record and a single expert study histology review of a representative histologic section from each case. RESULTS -The study included 60 invasive vulvar squamous cell carcinoma (SCC) cases, 6 Paget disease cases, 2 basal cell carcinoma cases, and 53 in situ cases. Comparing subtypes of invasive vulvar SCC, the registry agreed with the pathology report classification in 49 of 60 cases (81.7%). Study histology review identified the same SCC subtype as the registry in 9 of 60 cases (15.0%) and the same SCC subtype as the pathology report in 11 of 60 cases (18.3%). Whereas the registry and pathology reports classified 37 and 34 cases, respectively, as being SCC not otherwise specified, the study histology review identified a more specific subtype in all cases. CONCLUSIONS -Subtypes of vulvar cancer were frequently recorded as not otherwise specified in the cancer registry primarily because the pathology report often did not specify the histologic subtype. Vulvar cancer registry data are useful for tracking broad diagnostic categories, but are less reliable for vulvar cancer subtypes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Mona Saraiya
- From the Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia (Dr Siegel); the Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (Dr Saraiya and Mss Wilson and Watson), the Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (Drs Gargano and Unger), and the Epidemic Intelligence Service (Drs Gargano and Unger), Centers for Disease Control and Prevention, Atlanta, Georgia; the Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville (Dr Wilkinson); the University of Hawaii Cancer Center, University of Hawaii, Honolulu (Dr Hernandez); the Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California (Dr Goodman); and the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (Dr Lynch)
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183
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McKeage K, Lyseng-Williamson KA. 9-Valent human papillomavirus recombinant vaccine (Gardasil® 9): a guide to its use in the EU. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0337-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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184
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Nicolás-Párraga S, Gandini C, Pimenoff VN, Alemany L, de Sanjosé S, Xavier Bosch F, Bravo IG. HPV16 variants distribution in invasive cancers of the cervix, vulva, vagina, penis, and anus. Cancer Med 2016; 5:2909-2919. [PMID: 27654117 PMCID: PMC5083745 DOI: 10.1002/cam4.870] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 06/13/2016] [Accepted: 07/27/2016] [Indexed: 12/11/2022] Open
Abstract
Human papillomavirus (HPV)16 is the most oncogenic human papillomavirus, responsible for most papillomavirus‐induced anogenital cancers. We have explored by sequencing and phylogenetic analysis the viral variant lineages present in 692 HPV16‐monoinfected invasive anogenital cancers from Europe, Asia, and Central/South America. We have assessed the contribution of geography and anatomy to the differential prevalence of HPV16 variants and to the nonsynonymous E6 T350G polymorphism. Most (68%) of the variance in the distribution of HPV16 variants was accounted for by the differential abundance of the different viral lineages. The most prevalent variant (above 70% prevalence) in all regions and in all locations was HPV16_A1‐3, except in Asia, where HPV16_A4 predominated in anal cancers. The differential prevalence of variants as a function of geographical origin explained 9% of the variance, and the differential prevalence of variants as a function of anatomical location accounted for less than 3% of the variance. Despite containing similar repertoires of HPV16 variants, we confirm the worldwide trend of cervical cancers being diagnosed significantly earlier than other anogenital cancers (early fifties vs. early sixties). Frequencies for alleles in the HPV16 E6 T350G polymorphism were similar across anogenital cancers from the same geographical origin. Interestingly, anogenital cancers from Central/South America displayed higher 350G allele frequencies also within HPV16_A1‐3 lineage compared with Europe. Our results demonstrate ample variation in HPV16 variants prevalence in anogenital cancers, which is partly explained by the geographical origin of the sample and only marginally explained by the anatomical location of the lesion, suggesting that tissue specialization is not essential evolutionary forces shaping HPV16 diversity in anogenital cancers.
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Affiliation(s)
- Sara Nicolás-Párraga
- Infections and Cancer Unit, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain.,Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain
| | - Carolina Gandini
- Infections and Cancer Unit, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain.,Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain
| | - Ville N Pimenoff
- Infections and Cancer Unit, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain.,Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain
| | - Laia Alemany
- Infections and Cancer Unit, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain.,Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain
| | - Silvia de Sanjosé
- Infections and Cancer Unit, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain.,Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain.,CIBER in Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - F Xavier Bosch
- Infections and Cancer Unit, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain.,Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain
| | - Ignacio G Bravo
- Infections and Cancer Unit, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain. .,MIVEGEC, National Center for Scientific Research (CNRS), Montpellier, France.
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Bucchi D, Stracci F, Buonora N, Masanotti G. Human papillomavirus and gastrointestinal cancer: A review. World J Gastroenterol 2016; 22:7415-7430. [PMID: 27672265 PMCID: PMC5011658 DOI: 10.3748/wjg.v22.i33.7415] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/29/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. Exposure to HPV is very common, and an estimated 65%-100% of sexually active adults are exposed to HPV in their lifetime. The majority of HPV infections are asymptomatic, but there is a 10% chance that individuals will develop a persistent infection and have an increased risk of developing a carcinoma. The International Agency for Research on Cancer has found that the following cancer sites have a strong causal relationship with HPV: cervix uteri, penis, vulva, vagina, anus and oropharynx, including the base of the tongue and the tonsils. However, studies of the aetiological role of HPV in colorectal and esophageal malignancies have conflicting results. The aim of this review was to organize recent evidence and issues about the association between HPV infection and gastrointestinal tumours with a focus on esophageal, colorectal and anal cancers. The ultimate goal was to highlight possible implications for prognosis and prevention.
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186
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Félez-Sánchez M, Vergara M, de Sanjosé S, Castellsagué X, Alemany L, Bravo IG. Searching beyond the usual papillomavirus suspects in squamous carcinomas of the vulva, penis and head and neck. INFECTION GENETICS AND EVOLUTION 2016; 45:198-204. [PMID: 27600594 DOI: 10.1016/j.meegid.2016.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/02/2016] [Indexed: 01/17/2023]
Abstract
Human Papillomaviruses (HPVs) are involved in the etiology of anogenital and head and neck cancers. The HPV DNA prevalence greatly differs by anatomical site. Indeed, the high rates of viral DNA prevalence in anal and cervical carcinomas contrast with the lower fraction of cancer cases attributable to HPVs in other anatomical sites, chiefly the vulva, the penis and head and neck. Here we analyzed 2635 Formalin Fixed Paraffin Embedded surgical samples that had previously tested negative for the presence of HPVs DNA using the SPF10/DEIA procedure, in order to identify the presence of other PVs not explicitly targeted by standard molecular epidemiologic approaches. All samples were reanalyzed using five broad-PV PCR primer sets (CP1/2, FAP6064/FAP64, SKF/SKR, MY9/MY11, MFI/MFII) targeting the main PV main clades. In head and neck carcinoma samples (n=1141), we recovered DNA from two BetaHPVs, namely HPV20 and HPV21, and from three cutaneous AlphaPVs, namely HPV2, HPV57 and HPV61. In vulvar squamous cell carcinoma samples (n=902), we found one of the samples containing DNA of one cutaneous HPV, namely HPV2, and 29 samples contained DNA from essentially mucosal HPVs. In penile squamous cell carcinoma samples (n=592), we retrieved the DNA of HPV16 in 16 samples. Our results show first that the SPF10/DEIA is very sensitive, as we recovered only 2.1% (55/2635) false negative results; second, that although the DNA of cutaneous HPVs can be detected in cancer samples, their relative contribution remains anyway minor (0.23%; 6/2635) and may be neglected for screening and vaccination purposes; and third, their contribution to malignancy is not necessarily warranted and needs to be elucidated.
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Affiliation(s)
- Marta Félez-Sánchez
- Infections and Cancer Laboratory, Catalan Institute of Oncology (ICO) L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Institute of Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marleny Vergara
- Infections and Cancer Laboratory, Catalan Institute of Oncology (ICO) L'Hospitalet de Llobregat, Barcelona, Spain
| | - Silvia de Sanjosé
- Infections and Cancer Laboratory, Catalan Institute of Oncology (ICO) L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Institute of Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP). Instituto de Salud Carlos III, Madrid, Spain
| | - Xavier Castellsagué
- Infections and Cancer Laboratory, Catalan Institute of Oncology (ICO) L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Institute of Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laia Alemany
- Infections and Cancer Laboratory, Catalan Institute of Oncology (ICO) L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Institute of Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ignacio G Bravo
- Infections and Cancer Laboratory, Catalan Institute of Oncology (ICO) L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Institute of Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; MIVEGEC, National Center for Scientific Research (CNRS), Montpellier, France.
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Coffey K, Gaitskell K, Beral V, Canfell K, Green J, Reeves G, Barnes I. Past cervical intraepithelial neoplasia grade 3, obesity, and earlier menopause are associated with an increased risk of vulval cancer in postmenopausal women. Br J Cancer 2016; 115:599-606. [PMID: 27336599 PMCID: PMC4997536 DOI: 10.1038/bjc.2016.165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 04/08/2016] [Accepted: 04/30/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Vulval cancer predominantly affects postmenopausal women. A smaller proportion of vulval cancers, particularly at older ages, are now thought to be associated with human papillomavirus infection than previously reported, but other risk factors have not been well examined in prospective cohort studies. METHODS A total of 1.3 million women aged 49-65 years were followed for incident vulval cancer (ICD-10 C51). Adjusted Cox regression models were used to examine the relationship between reproductive and lifestyle factors and risk of vulval cancer. RESULTS There were 898 vulval cancers registered in the cohort over an average of 14 years of follow-up; 70% were squamous cell carcinomas. Past registration of cervical carcinoma in situ (RR 2.68; 95% CI 1.71-4.18; P<0.001), obesity (RR 1.71; 95% CI 1.44-2.04; P<0.0001), and menopause before the age of 50 years (RR 1.52; 95% CI 1.22-1.89; P<0.001) were associated with a significantly increased risk of subsequent vulval cancer. CONCLUSION Past cervical pre-cancer, obesity, and earlier age at menopause are associated with an increased risk of vulval cancer at older ages.
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Affiliation(s)
- Kate Coffey
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Kezia Gaitskell
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Valerie Beral
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales 2011, Australia
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jane Green
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Gillian Reeves
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Isobel Barnes
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - on behalf of the Million Women Study Collaborators4
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales 2011, Australia
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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189
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Moreira ED, Block SL, Ferris D, Giuliano AR, Iversen OE, Joura EA, Kosalaraksa P, Schilling A, Van Damme P, Bornstein J, Bosch FX, Pils S, Cuzick J, Garland SM, Huh W, Kjaer SK, Qi H, Hyatt D, Martin J, Moeller E, Ritter M, Baudin M, Luxembourg A. Safety Profile of the 9-Valent HPV Vaccine: A Combined Analysis of 7 Phase III Clinical Trials. Pediatrics 2016; 138:e20154387. [PMID: 27422279 DOI: 10.1542/peds.2015-4387] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The overall safety profile of the 9-valent human papillomavirus (9vHPV) vaccine was evaluated across 7 Phase III studies, conducted in males and females (nonpregnant at entry), 9 to 26 years of age. METHODS Vaccination was administered as a 3-dose regimen at day 1, and months 2 and 6. More than 15 000 subjects received ≥1 dose of 9vHPV vaccine. In 2 of the studies, >7000 control subjects received ≥1 dose of quadrivalent HPV (qHPV) vaccine. Serious and nonserious adverse events (AEs) and new medical conditions were recorded throughout the study. Subjects testing positive for pregnancy at day 1 were not vaccinated; those who became pregnant after day 1 were discontinued from further vaccination until resolution of the pregnancy. Pregnancies detected after study start (n = 2950) were followed to outcome. RESULTS The most common AEs (≥5%) experienced by 9vHPV vaccine recipients were injection-site AEs (pain, swelling, erythema) and vaccine-related systemic AEs (headache, pyrexia). Injection-site AEs were more common in 9vHPV vaccine than qHPV vaccine recipients; most were mild-to-moderate in intensity. Discontinuations and vaccine-related serious AEs were rare (0.1% and <0.1%, respectively). Seven deaths were reported; none were considered vaccine related. The proportions of pregnancies with adverse outcome were within ranges reported in the general population. CONCLUSIONS The 9vHPV vaccine was generally well tolerated in subjects aged 9 to 26 years with an AE profile similar to that of the qHPV vaccine; injection-site AEs were more common with 9vHPV vaccine. Its additional coverage and safety profile support widespread 9vHPV vaccination.
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Affiliation(s)
- Edson D Moreira
- Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Bahia, Brazil;
| | - Stan L Block
- Kentucky Pediatric/Adult Research, Inc, Bardstown, Kentucky
| | - Daron Ferris
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Anna R Giuliano
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida
| | | | - Elmar A Joura
- Department of Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Pope Kosalaraksa
- Department of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Andrea Schilling
- Departamento de Ginecología y Obstetricia Clínica Alemana, Facultad de Medicina Clínica Alemana-Universidad Del Desarrollo, Santiago, Chile
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center and Bar Ilan University Faculty of Medicine, Nahariya, Israel
| | | | - Sophie Pils
- Department of Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Jack Cuzick
- Wolfson Institute of Preventive Medicine, London, United Kingdom
| | - Suzanne M Garland
- Royal Women's Hospital, University of Melbourne and Murdoch Childrens Research Institute, Parkville, Australia
| | - Warner Huh
- Division of Gynecologic Oncology, University of Alabama Birmingham, Birmingham, Alabama
| | - Susanne K Kjaer
- Danish Cancer Society Research Center and Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hong Qi
- Merck & Co., Inc., Kenilworth, New Jersey; and
| | - Donna Hyatt
- Merck & Co., Inc., Kenilworth, New Jersey; and
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Sznurkowski JJ. Unclear role of human papillomavirus infection in response to adjuvant radiotherapy: conflicting results on the prognostic significance of irradiation in vulvar cancer patients with lymph node metastasis. Curr Med Res Opin 2016; 32:1387-8. [PMID: 27046126 DOI: 10.1080/03007995.2016.1174842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Jacek J Sznurkowski
- a Department of Surgical Oncology , The Medical University of Gdańsk , ul. Smoluchowskiego , Gdańsk , Poland
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191
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Epidemiology and Burden of Disease Associated with HPV Infection. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0174-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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192
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Sznurkowski JJ, Żawrocki A, Biernat W. The overexpression of p16 is not a surrogate marker for high-risk human papilloma virus genotypes and predicts clinical outcomes for vulvar cancer. BMC Cancer 2016; 16:465. [PMID: 27411473 PMCID: PMC4944532 DOI: 10.1186/s12885-016-2503-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 07/05/2016] [Indexed: 02/04/2023] Open
Abstract
Background We aimed to evaluate the correlation between p16ink4a-overexpression and high risk (hr)HPV-DNA in vulvar squamous cell carcinoma (vSCC) tumors as well as the impact of both biomarkers on the prognosis of vSCC patients. Methods PCR-detection of (hr)HPV-DNA and immunohistochemical staining for p16ink4a were conducted in 85 vSCC tumors. Survival analyses included the Kaplan–Meier method, log-rank test and Cox proportional hazards model. Results p16ink4a-overexpression and (hr)HPV-DNA were detected in 35 and 37 of the 85 tumors, respectively. Among the 35 p16ink4a-positive tumors, 10 lacked (hr)HPV-DNA (29 %). Among the 50 p16ink4a-negative tumors, (hr)HPV-DNA was detected in 12 cases (24 %). The median follow-up was 89.20 months (range 1.7–189.5 months). P16ink4a-overexpression, but not (hr)HPV-DNA positivity of the primary tumor, was correlated with prolonged overall survival (OS) (p = 0.009). P16ink4a-overexpression predicted a better response to radiotherapy (p < 0.001). Univariate analysis has demonstrated that age (p = 0.025), tumor grade (p = 0.001), lymph node metastasis (p < 0.001), FIGO stage (p < 0.001), p16ink4a-overexpression (p = 0.022), and adjuvant RTX (p < 0.001) were prognostic factors for OS. Multivariate analysis has demonstrated that lymph node metastasis (HR 1–2.74, 95 % CI 1.50–5.02, p = 0.019), tumor grade (HR 1–2.80, 95 % CI 1.33–5.90, p = 0.007) and p16ink4a-overexpression (HR 1–2.11, 95 % CI 1.13–3.95, p = 0.001) are independent prognostic factors. Conclusion The discovered overlap suggests the use of p16ink4a in combination with HPV-DNA detection as an ancillary test for future research and clinical studies in vSCC. The prognostic and predictive value of p16ink4a-overexpression should be tested in larger cohort studies. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2503-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jacek J Sznurkowski
- Department of Surgical Oncology, The Medical University of Gdańsk, ul. Smoluchowskiego 17, 80-214, Gdańsk, Poland.
| | - Anton Żawrocki
- Department of Pathology, The Medical University of Gdańsk, ul. Smoluchowskiego 17, 80-214, Gdańsk, Poland
| | - Wojciech Biernat
- Department of Pathology, The Medical University of Gdańsk, ul. Smoluchowskiego 17, 80-214, Gdańsk, Poland
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Madeleine MM, Johnson LG, Doody DR, Tipton ER, Carter JJ, Galloway DA. Natural Antibodies to Human Papillomavirus 16 and Recurrence of Vulvar High-Grade Intraepithelial Neoplasia (VIN3). J Low Genit Tract Dis 2016; 20:257-60. [PMID: 27224532 PMCID: PMC4920724 DOI: 10.1097/lgt.0000000000000227] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Approximately 30% of women treated for squamous high-grade intraepithelial neoplasia (VIN3), often associated with human papillomavirus (HPV), have recurrent disease. In this study, we assess predictors of recurrence that may provide targets for early prevention or treatment. MATERIALS AND METHODS Women with VIN3 who participated in a previous population-based case-control study with blood and tumor samples completed a follow-up telephone interview an average of 5 years after initial diagnosis. The risk of recurrence was determined by proportional hazards modeling. RESULTS Women with VIN3 in the follow-up study (n = 65) were similar to women with VIN3 in the parent study (n = 215) with regard to age at primary diagnosis, level of current cigarette smoking (>60%), and lifetime number of partners. We found that 22 (33.8%) of 65 participants had a vulvar recurrence and that 73.4% recurred within 3 years of treatment. Recurrences occurred more often among women with common warts in the decade before diagnosis (hazard ratio [HR] = 2.5, 95% CI = 1.1-5.8) and among those with a previous anogenital cancer (HR = 2.7, 95% CI = 1.2-6.3). Interestingly, recurrence was less frequent among women who mounted a natural antibody response to HPV16 (HR = 0.4, 95% CI = 0.2-0.9). CONCLUSIONS These data provide strong preliminary evidence that VIN3 recurrence was less frequent among those with HPV16 antibodies. Vaccination with the currently licensed HPV vaccine as part of adjunctive therapy for VIN3 would increase antibody response and may decrease risk of recurrence. Randomized controlled trials are needed to determine whether HPV vaccination is effective against VIN3 recurrence.
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Affiliation(s)
- Margaret M. Madeleine
- Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA; Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA; and Department of Microbiology, University of Washington, Seattle, WA
| | - Lisa G. Johnson
- Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA; Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA; and Department of Microbiology, University of Washington, Seattle, WA
| | - David R. Doody
- Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA; Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA; and Department of Microbiology, University of Washington, Seattle, WA
| | - Elaine R. Tipton
- Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA; Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA; and Department of Microbiology, University of Washington, Seattle, WA
| | - Joseph J. Carter
- Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA; Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA; and Department of Microbiology, University of Washington, Seattle, WA
| | - Denise A. Galloway
- Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA; Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA; and Department of Microbiology, University of Washington, Seattle, WA
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194
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Van Damme P, Meijer CJLM, Kieninger D, Schuyleman A, Thomas S, Luxembourg A, Baudin M. A phase III clinical study to compare the immunogenicity and safety of the 9-valent and quadrivalent HPV vaccines in men. Vaccine 2016; 34:4205-4212. [PMID: 27354258 DOI: 10.1016/j.vaccine.2016.06.056] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/13/2016] [Accepted: 06/17/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND A nine-valent human papilloma virus (9vHPV) vaccine has been developed to prevent infections and diseases related to HPV 6/11/16/18 (as per the licensed quadrivalent HPV (qHPV) vaccine) as well as to five additional oncogenic HPV types (HPV 31/33/45/52/58). The 9vHPV vaccine has the potential to prevent 90% of cervical cancers, HPV-related anal, vaginal and vulval cancers and anogenital warts. We compared the immunogenicity and safety of the 9vHPV vaccine versus the qHPV vaccine in 16-26-year-old men. METHODS Participants (N=500) were randomised to receive 9vHPV or qHPV vaccines on day 1, month 2 and month 6. Serology testing was performed on day 1 and month 7. HPV type-specific antibody titres (anti-HPV 6/11/16/18/31/33/45/52/58) were determined by competitive Luminex immunoassay and expressed as geometric mean titres and seroconversion rates. Vaccine safety was also assessed. RESULTS The HPV 6/11/16/18 immune responses elicited by the 9vHPV vaccine were comparable with those elicited by the qHPV vaccine. All participants receiving the 9vHPV vaccine seroconverted for HPV 31/33/45/52/58. The 9vHPV and qHPV vaccines showed comparable safety profiles. CONCLUSIONS In addition to immune responses to HPV 31/33/45/52/58, a three-dose regimen of the 9vHPV vaccine elicited a similar immune response to HPV 6/11/16/18 when compared with the qHPV vaccine in men aged 16-26years. The safety profile was also similar for the two vaccines. The results from this study support extending the efficacy findings with qHPV vaccine to 9vHPV vaccine in men aged 16-26years. NCT02114385.
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Affiliation(s)
- Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Universiteitsplein 1, 2610 WIlrijk, Belgium.
| | - Chris J L M Meijer
- VU University Medical Centre, De Boelelaan 1117, 1084HV Amsterdam, The Netherlands.
| | - Dorothee Kieninger
- Centre for Clinical Trials, Children's Hospital, Universitätsmedizin, Mainz, Germany.
| | | | | | - Alain Luxembourg
- Merck & Co. Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA.
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195
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Bleeker MCG, Visser PJ, Overbeek LIH, van Beurden M, Berkhof J. Lichen Sclerosus: Incidence and Risk of Vulvar Squamous Cell Carcinoma. Cancer Epidemiol Biomarkers Prev 2016; 25:1224-30. [PMID: 27257093 DOI: 10.1158/1055-9965.epi-16-0019] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/11/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The association between lichen sclerosus and vulvar squamous cell carcinoma (VSCC) has long been recognized, but large epidemiologic studies are lacking. METHODS Data of women diagnosed with vulvar pathology in the Netherlands were retrieved from the Dutch Pathology Registry. All vulvar pathology reports of this historical cohort were reviewed to construct a research database, including 3,038 women with lichen sclerosus diagnosed between 1991 and 2011. The incidence rate of lichen sclerosus and the cumulative incidence of VSCC among women with lichen sclerosus were estimated. RESULTS Between 1991 and 2011, the incidence rate of lichen sclerosus increased from 7.4 to 14.6 per 100,000 woman-years. The median age at time of lichen sclerosus diagnosis was 59.8 years and the cumulative VSCC incidence was 6.7%. The 10-year VSCC incidence in women with lichen sclerosus was associated with concurrent vulvar intraepithelial neoplasia (VIN; 18.8% in women with VIN and 2.8% in women without VIN) and age at time of lichen sclerosus diagnosis (5.9% in women of ≥70 years, 3% in women between 50 and 70 years, and 1.8% in women <50 years). The effects of presence of VIN and age remained significant in adjusted Cox regression analysis. CONCLUSION This historical cohort showed a nearly 100% increase in incidence of lichen sclerosus between 1991 and 2011. Concurrent VIN and age ≥70 years at time of lichen sclerosus diagnosis are important risk factors for vulvar cancer development. IMPACT The incidence of lichen sclerosus is rising and special attention is needed in particular in women with concurrent VIN because of their high risk of cancer. Cancer Epidemiol Biomarkers Prev; 25(8); 1224-30. ©2016 AACR.
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Affiliation(s)
- Maaike C G Bleeker
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands.
| | - Pascal J Visser
- Faculty of Medicine, VU University, Amsterdam, the Netherlands
| | - Lucy I H Overbeek
- Foundation PALGA, the Dutch Pathology Registry, Houten, the Netherlands
| | - Marc van Beurden
- Department of Gynecology, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
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196
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Hoang LN, Park KJ, Soslow RA, Murali R. Squamous precursor lesions of the vulva: current classification and diagnostic challenges. Pathology 2016; 48:291-302. [PMID: 27113549 PMCID: PMC5518939 DOI: 10.1016/j.pathol.2016.02.015] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 02/08/2016] [Accepted: 02/12/2016] [Indexed: 01/11/2023]
Abstract
Growing evidence has established two major types of vulvar intraepithelial neoplasia (VIN), which correspond to two distinct oncogenic pathways to vulvar squamous cell carcinoma (VSCC). While the incidence of VSCC has remained relatively stable over the last three decades, the incidence of VIN has increased. VIN of usual type (uVIN) is human papillomavirus (HPV)-driven, affects younger women and is a multicentric disease. In contrast, VIN of differentiated type (dVIN) occurs in post-menopausal women and develops independent of HPV infection. dVIN often arises in a background of lichen sclerosus and chronic inflammatory dermatoses. Although isolated dVIN is significantly less common than uVIN, dVIN bears a greater risk for malignant transformation to VSCC and progresses over a shorter time interval. On histological examination, uVIN displays conspicuous architectural and cytological abnormalities, while the morphological features that characterise dVIN are much more subtle and raise a wide differential diagnosis. On the molecular level, dVIN is characterised by a higher number of somatic mutations, particularly in TP53. Here we review the classification, epidemiology, clinical features, histomorphology, ancillary markers and molecular genetics of both types of VIN, and discuss the morphological challenges faced by pathologists in interpreting these lesions.
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Affiliation(s)
- Lien N Hoang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kay J Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert A Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rajmohan Murali
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Marie-Josee and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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197
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Garland SM, Kjaer SK, Muñoz N, Block SL, Brown DR, DiNubile MJ, Lindsay BR, Kuter BJ, Perez G, Dominiak-Felden G, Saah AJ, Drury R, Das R, Velicer C. Impact and Effectiveness of the Quadrivalent Human Papillomavirus Vaccine: A Systematic Review of 10 Years of Real-world Experience. Clin Infect Dis 2016; 63:519-27. [PMID: 27230391 PMCID: PMC4967609 DOI: 10.1093/cid/ciw354] [Citation(s) in RCA: 314] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/18/2016] [Indexed: 12/17/2022] Open
Abstract
This systematic review assessed the global impact and effectiveness of quadrivalent human papillomavirus (HPV) vaccination on HPV infection and disease in real-world settings over a decade of use. Substantial reductions in HPV 6/11/16/18 infection, anogenital warts, and cervical lesions have been achieved. Prophylactic human papillomavirus (HPV) vaccination programs constitute major public health initiatives worldwide. We assessed the global effect of quadrivalent HPV (4vHPV) vaccination on HPV infection and disease. PubMed and Embase were systematically searched for peer-reviewed articles from January 2007 through February 2016 to identify observational studies reporting the impact or effectiveness of 4vHPV vaccination on infection, anogenital warts, and cervical cancer or precancerous lesions. Over the last decade, the impact of HPV vaccination in real-world settings has become increasingly evident, especially among girls vaccinated before HPV exposure in countries with high vaccine uptake. Maximal reductions of approximately 90% for HPV 6/11/16/18 infection, approximately 90% for genital warts, approximately 45% for low-grade cytological cervical abnormalities, and approximately 85% for high-grade histologically proven cervical abnormalities have been reported. The full public health potential of HPV vaccination is not yet realized. HPV-related disease remains a significant source of morbidity and mortality in developing and developed nations, underscoring the need for HPV vaccination programs with high population coverage.
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Affiliation(s)
- Suzanne M Garland
- Royal Women's Hospital, University of Melbourne, Murdoch Childrens Research Institute, Victoria, Australia
| | - Susanne K Kjaer
- Danish Cancer Society Research Center and Department of Gynecology, Rigshospitalet, University of Copenhagen, Denmark
| | - Nubia Muñoz
- Colombian National Institute of Cancer, Bogota
| | - Stan L Block
- Kentucky Pediatric and Adult Research, Bardstown
| | | | | | | | | | - Gonzalo Perez
- Merck & Co, Inc, Kenilworth, New Jersey Universidad del Rosario, Bogota, Colombia
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198
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[HPV DNA genotyping: A study of anogenital, head and neck and skin cancers in a population from west Algerian. HPV detection in different cancers from an Algerian population]. Bull Cancer 2016; 103:455-60. [PMID: 27085765 DOI: 10.1016/j.bulcan.2016.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/10/2016] [Accepted: 02/29/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To investigate the prevalence of human papillomaviruses (HPV) in cancers located at different sites in patients from west Algerian and collected between 2010 and 2014. MATERIAL AND METHODS Extracted DNA from archival formaldehyde-fixed and paraffin-embedded tissues was provided from 39 anogenital cancers, 10 head and neck cancers and 36 skin cancers. The viral DNA was detected using the INNO-LiPA HPV Genotyping Extra(®) kit. RESULTS The prevalence of HPV was 100% in cervical cancers, 40% in vaginal cancers, 17% in vulvar cancers, 33% in anal cancers, 0% in tonsil and larynx cancers and 6.4% in skin squamous cell carcinoma. In cervical cancers, the most prevalent genotypes were HPV16 (52%) and HPV18 (12%) as single infection. CONCLUSION The overall results agree partially with literature. Extensive research is necessary to promote HPV vaccine to reduce in particular the burden of cervical cancer in Algeria.
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199
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Zhai L, Tumban E. Gardasil-9: A global survey of projected efficacy. Antiviral Res 2016; 130:101-9. [PMID: 27040313 DOI: 10.1016/j.antiviral.2016.03.016] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/29/2016] [Indexed: 02/07/2023]
Abstract
Human papillomaviruses (HPVs) are the causative agents of human neoplasias such as warts and cancers. There are ∼19 HPV types associated with cancers, which has made it very challenging for first generation HPV vaccines to offer complete protection against all cancer-causing HPV types. Recently, a second generation HPV vaccine, Gardasil-9, has been approved to protect against more HPV types. Worldwide, Gardasil-9 will protect against HPV types associated with ∼90% of cervical cancer case in women and 80-95% of other HPV-associated anogenital cancers in both men and women. However, due to variation in HPV-type specific prevalence and distribution, the vaccine will offer different percentages of protection in different geographical regions; Gardasil-9 will offer protection against HPV types associated with ∼87.7% of cervical cancers in Asia, 91.7% in Africa, 92% in North America, 90.9% in Europe, 89.5% in Latin America & the Caribbean, and 86.5% in Australia. Because of this, Pap smear screening and testing for HPV types not included in Gardasil-9 will need to continue, especially in HIV/AIDS patients. In order to achieve complete protection against all HPV types that cause cervical cancer, a third-generation HPV vaccine is needed.
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Affiliation(s)
- Lukai Zhai
- Department of Biological Sciences, Michigan Technological University, Houghton, MI 49931, United states
| | - Ebenezer Tumban
- Department of Biological Sciences, Michigan Technological University, Houghton, MI 49931, United states.
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Cao H, Wang S, Zhang Z, Lou J. Prognostic Value of Overexpressed p16INK4a in Vulvar Cancer: A Meta-Analysis. PLoS One 2016; 11:e0152459. [PMID: 27031618 PMCID: PMC4816296 DOI: 10.1371/journal.pone.0152459] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/15/2016] [Indexed: 01/08/2023] Open
Abstract
Objective This study aimed to examine the prognostic value of overexpressed p16INK4a in vulvar cancer. Although the tumor suppressor p16INK4a has been shown to be of prognostic value in a wide variety of cancers and precancerous lesions, its role in the vulvar cancer is still unclear. Methods All publications in English language on the association between p16INK4a and clinicopathological features of vulvar cancer were searched from Pubmed, Embase, and Web of Science, and those in Chinese language were identified manually and online from the China National Knowledge Infrastructure. Strict inclusion and exclusion criteria were followed. Odds ratios(ORs) or risk ratios(RRs) with 95% confidence intervals(CIs) were pooled to assess the strength of association. Publication bias was estimated using funnel plots and the Egger’s regression test. Results A total of 17 studies with 2309 patients were included. The p16INK4a overexpression was found to correlate significantly with the lower International Federation of Gynecology and Obstetrics stage(I+II vs III+IV; OR = 0.60,95%CI:0.41–0.86,P = 0.006),negative lymph node metastasis(negative vs positive; OR = 0.61,95%CI:0.39–0.95,P = 0.029),patient’s age<55(OR = 0.54,95%CI:0.31–0.96,P = 0.034),human papillomavirus–positive status(OR = 0.01,95%CI:0.00–0.11,P<0.001),and higher overall survival(RR = 0.53,95%CI = 0.35–0.80,P = 0.003). Conclusion The p16INK4a might be associated with a higher survival and indicates better prognosis of vulvar cancer.
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Affiliation(s)
- Hanyu Cao
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Si Wang
- Genome Stability Laboratory, West China Second University Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Zhenyu Zhang
- Key Laboratory of Birth and Related Diseases of Women and Children, Sichuan University Ministry of Education, Chengdu City, Sichuan Province, China
| | - Jiangyan Lou
- Key Laboratory of Birth and Related Diseases of Women and Children, Sichuan University Ministry of Education, Chengdu City, Sichuan Province, China
- * E-mail:
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