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Sharma P, Gautam SD, Rajendra S. Importance of investigating high-risk human papillomavirus in lymph node metastasis of esophageal adenocarcinoma. World J Gastroenterol 2020; 26:2729-2739. [PMID: 32550750 PMCID: PMC7284187 DOI: 10.3748/wjg.v26.i21.2729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/18/2020] [Accepted: 05/21/2020] [Indexed: 02/06/2023] Open
Abstract
High-risk human papillomavirus has been suggested as a risk factor for esophageal adenocarcinoma. Tumor human papillomavirus status has been reported to confer a favorable prognosis in esophageal adenocarcinoma. The size of the primary tumor and degree of lymphatic spread determines the prognosis of esophageal carcinomas. Lymph node status has been found to be a predictor of recurrent disease as well as 5-year survival in esophageal malignancies. In human papillomavirus driven cancers, e.g. cervical, anogenital, head and neck cancers, associated lymph nodes with a high viral load suggest metastatic lymph node involvement. Thus, human papillomavirus could potentially be useful as a marker of micro-metastases. To date, there have been no reported studies regarding human papillomavirus involvement in lymph nodes of metastatic esophageal adenocarcinoma. This review highlights the importance of investigating human papillomavirus in lymph node metastasis of esophageal adenocarcinoma based on data derived from other human papillomavirus driven cancers.
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Affiliation(s)
- Preeti Sharma
- Gastro-Intestinal Viral Oncology Group, Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Kensington, Sydney, New South Wales 2052, Australia
| | - Shweta Dutta Gautam
- Gastro-Intestinal Viral Oncology Group, Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Kensington, Sydney, New South Wales 2052, Australia
| | - Shanmugarajah Rajendra
- Gastro-Intestinal Viral Oncology Group, Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Kensington, Sydney, New South Wales 2052, Australia
- Department of Gastroenterology & Hepatology, Bankstown-Lidcombe Hospital, South Western Sydney Local Health Network, Bankstown, Sydney, New South Wales 2200, Australia
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Dundr P, Cibula D, Němejcová K, Tichá I, Bártů M, Jakša R. Pathologic Protocols for Sentinel Lymph Nodes Ultrastaging in Cervical Cancer. Arch Pathol Lab Med 2019; 144:1011-1020. [PMID: 31869245 DOI: 10.5858/arpa.2019-0249-ra] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Ultrastaging of sentinel lymph nodes (SLNs) is a crucial aspect in the approach to SLN processing. No consensual protocol for pathologic ultrastaging has been approved by international societies to date. OBJECTIVE.— To provide a review of the ultrastaging protocol and all its aspects related to the processing of SLNs in patients with cervical cancer. DATA SOURCES.— In total, 127 publications reporting data from 9085 cases were identified in the literature. In 24% of studies, the information about SLN processing is entirely missing. No ultrastaging protocol was used in 7% of publications. When described, the differences in all aspects of SLN processing among the studies and institutions are substantial. This includes grossing of the SLN, which is not completely sliced and processed in almost 20% of studies. The reported protocols varied in all aspects of SLN processing, including the thickness of slices (range, 1-5 mm), the number of levels (range, 0-cut out until no tissue left), distance between the levels (range, 40-1000 μm), and number of sections per level (range, 1-5). CONCLUSIONS.— We found substantial differences in protocols used for SLN pathologic ultrastaging, which can impact sensitivity for detection of micrometastases and even small macrometastases. Since the involvement of pelvic lymph nodes is the most important negative prognostic factor, such profound discrepancies influence the referral of patients to adjuvant radiotherapy and could potentially cause treatment failure. It is urgent that international societies agree on a consensual protocol before SLN biopsy without pelvic lymphadenectomy is introduced into routine clinical practice.
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Affiliation(s)
- Pavel Dundr
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - David Cibula
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Kristýna Němejcová
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Ivana Tichá
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Michaela Bártů
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Radek Jakša
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
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Chen P, Zhang W, Yang D, Zhang W, Gao S. Human Papillomavirus Status in Primary Lesions and Pelvic Lymph Nodes and Its Prognostic Value in Cervical Cancer Patients with Lymph Node Metastases. Med Sci Monit 2019; 25:1894-1902. [PMID: 30864560 PMCID: PMC6427929 DOI: 10.12659/msm.914564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The aim of this study was to assess the presence of HPV DNA in cervical tissues and lymph nodes in patients who have uterine cervical neoplasms with lymphatic metastases and who underwent surgery for invasive cervical cancer and pelvic lymphadenectomy, to establish the utility of HPV type and viral load in predicting disease progression. Material/Methods We retrospectively assessed 88 patients with uterine cervical neoplasms with lymph node metastases. All 88 patients were in FIGO stage IA-IIB. A total of 316 paraffin-embedded archival tissues (88 cervical samples and 228 pelvic lymph node specimens) were acquired. All the samples were analyzed using real-time PCR to determine HPV DNA presence/type and to quantify viral load. Results In total, 17 HPV genotypes were detected in the cervical lesions and pelvic lymph nodes of the patients. The most common HPV type in all samples was HPV16, followed by HPV18. The existence of HPV16 DNA and low HPV16 viral load in cervical lesions were also significantly associated with disease recurrence. Furthermore, lymphovascular space involvement was also correlated with worse disease outcome. Conclusions HPV16 DNA presence and low viral load in primary lesions can be used to predict disease recurrence. HPV DNA is a favorable prognostic indicator in patients with uterine cervical neoplasms who have lymphatic metastases.
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Affiliation(s)
- Peng Chen
- Department of Obstetrics and Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China (mainland)
| | - Weiyuan Zhang
- Department of Obstetrics and Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China (mainland)
| | - Dong Yang
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Weiyang Zhang
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Si Gao
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
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Fuglsang K, Blaakaer J, Petersen LK, Mejlgaard E, Hammer A, Steiniche T. Detection of high-risk human papillomavirus DNA in tissue from primary cervical cancer tumor, pelvic lymph nodes and recurrent disease. PAPILLOMAVIRUS RESEARCH 2018; 7:15-20. [PMID: 30557633 PMCID: PMC6313832 DOI: 10.1016/j.pvr.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 12/08/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023]
Abstract
Objectives The present study investigated Human Papillomavirus (HPV) DNA genotyping in primary tumor, pelvic lymph nodes (PLN) and recurrence in early-stage cervical cancer patients. Methods We conducted a hospital-based case-control study. From 2003 to 2015, 282 patients underwent surgery for cervical cancer in the Department of Gynecology, Aarhus University Hospital, Denmark. Twenty-nine recurrent cases were identified. HPV DNA genotyping was performed on formalin-fixed, paraffin-embedded tissue specimens from the primary tumor, PLN, and recurrent disease. Results In the primary tumor, HPV DNA was detectable in 18(72%) of 25 tissue specimens from recurrent cases and in 15(83%) of 18 controls. HPV DNA-positive PLN was significantly associated with recurrence, 83%(95%CI: 52–98%), compared to patients with HPV-negative PLN, 38%(95%CI: 18–62%)(p < 0.05). HPV DNA genotyping was positive in eight of 12(67%) patients with recurrent disease. The genotype was identical in all three tissues types. The positive predictive value for recurrence was the same for detection of HPV-DNA and metastases in the PLN, with reasonable sensitivity. The negative predictive value for recurrence, however, was best for HPV-DNA, 62%(95%CI: 38–98%). Conclusions In conclusion, our data suggest that the presence of HPV in pelvic lymph nodes is associated with an increased risk of recurrence.
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Affiliation(s)
- Katrine Fuglsang
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.
| | - Jan Blaakaer
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Lone Kjeld Petersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Else Mejlgaard
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Hammer
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Torben Steiniche
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
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Barut MU, Yildirim E, Kahraman M, Bozkurt M, Imirzalioğlu N, Kubar A, Çalişkan E, Sak S, Aksu T. Human Papilloma Viruses and Their Genotype Distribution in Women with High Socioeconomic Status in Central Anatolia, Turkey: A Pilot Study. Med Sci Monit 2018; 24:58-66. [PMID: 29298972 PMCID: PMC5764117 DOI: 10.12659/msm.906652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background In the present study we retrospectively evaluated the results of outpatients who had an HPV analysis, and present objective evidence for the administration of preventive inoculation in our area. Material/Methods We retrospectively reviewed 532 outpatients who visited a single center between 2012 and 2016 and had an HPV infection analysis. The criteria for inclusion of patients with unhealthy cervix in the study were: erosion, chronic cervicitis, healed lacerations, hypertrophied cervix, and abnormal discharges from the cervix. Results We found that 122 out of 532 patients were infected with HPV, and the rate of multiple infections was 59.0% (72/122). HR-HPV (group 1 carcinogens HPV-16 (18.9%, 23/122), HPV-18 (13.1%, 16/122), HPV- 31 (4.9%, 6/122), HPV-33 (3.3%, 4/122), HPV-35 (7.4.9%/122), HPV-39 (5.7%, 7/122), HPV-45 (5.7%, 7/122), HPV-51 (11.5%, 15/122); Group 3 LR-HPV; HPV-6 (31.1%, 38/122), HPV-11 (26.2%, 32/122), HPV-42 (9.0%, 11/122) and HPV-43 (4.9%, 6/122). In terms of linear-by-linear association test, no significant statistical difference was identified between years. The P value for HPV infection rate on year basis was P>0.05. Conclusions In this hospital-based retrospective analysis, HPV types were found to be similar to HPV types reported in developed countries. We firmly suggest that patients should be informed about the risk of HPV infection at early ages.
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Affiliation(s)
- Mert Ulaş Barut
- Department of Obstetrics and Gynecology, Harran University School of Medicine, Şanlıurfa, Turkey
| | - Engin Yildirim
- Department of Obstetrics and Gynecology, Public Hospital, Malatya, Turkey
| | - Mehmet Kahraman
- Department of Obstetrics and Gynecology, Public Hospital, Niğde, Turkey
| | - Murat Bozkurt
- Department of Obstetrics and Gynecology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Necat Imirzalioğlu
- Department of Obstetrics and Gynecology, Health Research System In Vitro Fertilization (HRS IVF) Center, Ankara, Turkey
| | - Ayhan Kubar
- Department of Obstetrics and Gynecology, Health Research System In Vitro Fertilization (HRS IVF) Center, Ankara, Turkey
| | - Eray Çalişkan
- Department of Obstetrics and Gynecology, Bahcesehir University, Istanbul, Turkey
| | - Sibel Sak
- Department of Obstetrics and Gynecology, Harran University School of Medicine, Şanlıurfa, Turkey
| | - Tarık Aksu
- Department of Obstetrics and Gynecology, Health Research System In Vitro Fertilization (HRS IVF) Center, Ankara, Turkey
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Analysis of epidemiological trends in human papillomavirus infection among gynaecological outpatients in Hangzhou, China, 2011-2015. BMC Infect Dis 2017; 17:393. [PMID: 28583102 PMCID: PMC5460518 DOI: 10.1186/s12879-017-2498-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 05/28/2017] [Indexed: 12/28/2022] Open
Abstract
Background HPV infection is the major pathogenic factor underlying cervical cancer and precancerous lesions. The cervical HPV infection rates in gynaecological outpatients from Hangzhou, China, were studied in the period from January 2011 to December 2015. Methods Exfoliated cervical cells were harvested from gynaecological outpatients in Hangzhou from January 2011 to December 2015. Twenty-one HPV subtypes were detected using flow-through hybridization. The HPV infection rates in various disease groups were compared using the Chi-square test. The infection rates of different HPV subtypes in different calendar years and in different age groups were analysed using the linear-by-linear association test and gamma value. Results A total of 43,804 patients were recruited, of whom 9752 (22.3%) were infected with HPV. The top five among the 21 HPV subtypes detected in terms of infection rates were HPV-16, −52, −58, −53 and −18. No significant differences (linear-by-linear association test) were found in the HPV infection rates when compared over the studied years (P > 0.05). However, the 15–24-year-old age group showed the highest HPV infection rate, and significant differences (linear-by-linear association test) were detected among the different age groups (P < 0.05). The HPV infection rates exhibited an upward trend in the 15–24-year-old and >24–34-year-old groups over the past five years. There were significant differences in the HPV infection rates among the disease groups (P < 0.05). Conclusions HPV-16, −52 and −58 were the major HPV infection subtypes in Hangzhou, China. The 15–24-year-old age group had a relatively high HPV infection rate with an upward trend over the past five years and thus represented a population susceptible to HPV infection.
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Tortora M, Annunziata C, Liguori G, Losito S, Botti G, Greggi S, Buonaguro L, Buonaguro FM, Tornesello ML. Detection of human papillomavirus DNA in peri-tumor tissues and pelvic lymph nodes as potential molecular marker of micrometastasis in cervical cancer. Infect Agent Cancer 2016; 11:22. [PMID: 27175213 PMCID: PMC4863320 DOI: 10.1186/s13027-016-0068-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/01/2016] [Indexed: 12/20/2022] Open
Abstract
Background The association between high risk human papillomaviruses (HPV) and cervical cancer has been firmly established. HPV genome is present in nearly all cases of cervical cancer and detection of viral DNA could therefore be used as a surrogate marker of micrometastasis in peri-tumor tissues and lymph nodes. Methods We analyzed primary cervical carcinomas, peri-tumor biopsies and pelvic lymph nodes in 20 women with invasive cancer (FIGO stage I-II) who underwent radical pelvic surgery and lymphadenectomy. HPV DNA was searched by broad spectrum PCR in 142 DNA samples extracted from paraffin embedded tissues. Viral genotypes were identified by direct sequencing analysis. Results HPV DNA sequences were identified in all available primary cervical tumors (n = 15). The most common genotype was HPV16 (60 %), followed by HPV18 (20 %), HPV35 (7 %), HPV45 (7 %) and HPV66 (7 %). Seven out of 20 (35 %) women had metastatic spread in peri-tumor tissues and/or lymph nodes, as determined by histology. HPV DNA was detected in all histological positive samples as well as in 16 and 25 % of histological negative peri-tumor tissues and lymph nodes, respectively. Three out of 20 (15 %) women without histological evidence of metastatic spread had HPV-positive lymph nodes. HPV genotype was found always concordant between primary tumor and metastatic lesions. The remaining 10 women (50 %) were histology and HPV-negative in all peri-tumor biopsies and lymph nodes analyzed. Conclusions Evaluation of HPV DNA in peri-tumor tissues as well as pelvic lymph nodes could be a sensitive marker to identify micrometastasis or isolated tumor cells and to monitor the risk of disease recurrence in women with cervical cancer.
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Affiliation(s)
- Marianna Tortora
- Molecular Biology and Viral Oncology Division, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, 80131 Napoli, Italy
| | - Clorinda Annunziata
- Molecular Biology and Viral Oncology Division, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, 80131 Napoli, Italy
| | - Giuseppina Liguori
- Department of Pathology, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, Napoli, 80131 Italy
| | - Simona Losito
- Department of Pathology, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, Napoli, 80131 Italy
| | - Gerardo Botti
- Department of Pathology, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, Napoli, 80131 Italy
| | - Stefano Greggi
- Division of Gynecology, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, Napoli, 80131 Italy
| | - Luigi Buonaguro
- Molecular Biology and Viral Oncology Division, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, 80131 Napoli, Italy
| | - Franco M Buonaguro
- Molecular Biology and Viral Oncology Division, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, 80131 Napoli, Italy
| | - Maria Lina Tornesello
- Molecular Biology and Viral Oncology Division, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, 80131 Napoli, Italy
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Noventa M, Ancona E, Cosmi E, Saccardi C, Litta P, D'Antona D, Nardelli GB, Gizzo S. Usefulness, methods and rationale of lymph nodes HPV-DNA investigation in estimating risk of early stage cervical cancer recurrence: a systematic literature review. Clin Exp Metastasis 2014; 31:853-67. [PMID: 25039008 DOI: 10.1007/s10585-014-9670-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 07/08/2014] [Indexed: 01/29/2023]
Abstract
Metastatic involvement of pelvic lymph-nodes (LNs), generally found in 0-29.3 % of early stages, is the most important prognostic factor in cervical cancer (CC). However, even in non-metastatic LNs, recurrence rate reaches 10-15 %. The role of HPV-DNA presence in pelvic LNs has been a point of debate in the last two decades. The aim of this systematic review is to collect all available data about LNs HPV-DNA detection in patients affected by early-stage CC in order to elucidate its clinical and surgical usefulness to choose the best surgical treatment, the necessity of adjuvant therapy and to estimate the overall oncological prognosis. The available data in this field results very patchy and often conflicting in the results. The high correlation between HPV-DNA genome detected in primary lesion and the one detected in LNs, as well as the high correlation between LNs metastatic involvement and HPV-DNA presence, lead to hypothesize that LNs HPV presence represents a potential risk-factor for recurrence and poor oncological prognosis. The large disparities in recurrence-rate of cases with LNs positive for HPV-DNA test and negative for metastases could be explained by the relative "inappropriateness" of PCR test to discriminate the presence of HPV-genome alone (condition necessary but not sufficient) or in association with squamous cells (condition necessary and sufficient). The use of ISH test for HPV-DNA detection in LNs, particularly if associated to CK19-assay, improve the accuracy of micro-metastasis detection, and the identification of patients with negative histology but potentially at high-risk of recurrence and poor oncological prognosis.
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Affiliation(s)
- Marco Noventa
- Department of Woman and Child Health, University of Padua, Padua, Italy
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Noventa M, Ancona E, Saccardi C, Litta P, D'Antona D, Nardelli GB, Gizzo S. Could HPV-DNA test solve the dilemma about sentinel node frozen section accuracy in early stage cervical cancer? Hypothesis and rationale. Cancer Invest 2014; 32:206-7. [PMID: 24605898 DOI: 10.3109/07357907.2014.889707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In order to reduce the surgical invasiveness in early-stage cervical-cancer treatment, the sentinel lymph-node (SLN) technique could be considered as a possible intraoperative-guidance to lymphadenectomy decision making. Unfortunately its accuracy ranges between 33.3% and 100% in different studies. Recent manuscripts suggest that HPV-DNA presence in pelvic-lymph-nodes may represent a molecular marker of micrometastases. According to this hypothesis, the rationale in proposing the HPV-DNA-test when negative frozen-section occurs is due to the expected improvement of its diagnostic-accuracy. HPV-DNA test may represent a marker able to discriminate at frozen section the false-negative from the truth-negative tests filling the gap between optimal and real frozen-section accuracy.
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Affiliation(s)
- Marco Noventa
- Department of Woman and Child Health, University of Padua, Padua, Italy
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Farley J, Sill MW, Birrer M, Walker J, Schilder RJ, Thigpen JT, Coleman RL, Miller BE, Rose PG, Lankes HA. Phase II study of cisplatin plus cetuximab in advanced, recurrent, and previously treated cancers of the cervix and evaluation of epidermal growth factor receptor immunohistochemical expression: a Gynecologic Oncology Group study. Gynecol Oncol 2011; 121:303-8. [PMID: 21329967 DOI: 10.1016/j.ygyno.2011.01.030] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 01/21/2011] [Accepted: 01/25/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the safety and efficacy of cetuximab (C225), an antibody that inhibits epidermal growth factor receptor (EGFR) activity, with cisplatin and to explore associations between EGFR protein expression with patient demographics or clinical outcome. METHODS Women with advanced, persistent, or recurrent carcinoma of the cervix were eligible. The women received cisplatin at 30mg/m(2) on days 1 and 8 with a loading dose of cetuximab at 400mg/m(2) followed by 250mg/m(2) on days 1, 8, and 15 in a 21day cycle. Adverse events were assessed with CTCAE v 3.0. Primary measure of efficacy was tumor response by RECIST. The study was stratified by prior chemotherapy (CT). EGFR protein expression in pre-treatment tumor was analyzed by immunohistochemistry. RESULTS Between September 2004 and March 2008, 76 patients were enrolled. Of these, 69 were eligible and evaluable; 44 (64%) received prior chemotherapy. There were 4 responses in each group, prior chemotherapy and no chemotherapy, 9% and 16%, respectively. Grade 4 toxicities included anemia (1), allergy (1), metabolic (1), and vascular (1). The most common grade 3 toxicities were metabolic (15), dermatologic (8), fatigue (6), and gastrointestinal (6). EGFR protein was expressed in 47/48 (98%) of tumors analyzed with a median cellular expression of 81%. Exploratory analyses revealed a trend between the percentage of cells expressing EGFR protein and PFS (hazard ratio=1.76, 95% confidence interval=0.96-3.21). CONCLUSIONS The combination of cetuximab with cisplatin was adequately tolerated but did not indicate additional benefit beyond cisplatin therapy.
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Affiliation(s)
- John Farley
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
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Slama J, Drazdakova M, Dundr P, Fischerova D, Zikan M, Pinkavova I, Freitag P, Fanta M, Kuzel D, Zima T, Cibula D. High-risk human papillomavirus DNA in paraaortic lymph nodes in advanced stages of cervical carcinoma. J Clin Virol 2010; 50:46-9. [PMID: 21035386 DOI: 10.1016/j.jcv.2010.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 09/24/2010] [Accepted: 09/29/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Paraaortic lymph nodes represent the second level in the lymphatic spread of cervical cancer. Recent studies have confirmed the association of HPV DNA in pelvic lymph nodes in early-stage disease with metastatic involvement and a less favourable prognosis. OBJECTIVE The aim of our study was to detect 13 high-risk genotypes of HPV in paraaortic nodes harvested from patients with FIGO IB2-IIIB tumours and correlate findings with histopathology. STUDY DESIGN The study involved patients with advanced cervical cancer who had undergone low paraaortic lymphadenectomy. The cytobrush technique was used for perioperative sample collection from the tumour and fresh lymphatic tissue. Patients with non-HPV related cancers were used as a control group. RESULTS The study involved 24 cervical cancer patients. High-risk HPV DNA was found in the primary tumour of all cases and in PALN in 16 (67%) cases. The most frequent genotype was HPV 16, both in the tumour and in the paraaortic lymph nodes (83% and 54%, respectively). Metastatic involvement of paraaortic lymph nodes was identified in 8 cases (33%), which all were also HPV DNA positive. No HPV DNA was detected in PALN in any of 22 control group cases. CONCLUSIONS Using the cytobrush technique, the presence of at least one HR HPV genotype in the primary tumour was identified in all the patients. The metastatically involved paraaortic lymph nodes always contained the DNA of at least one HPV genotype present in the primary tumour. Determination of clinical significance of HR HPV DNA presence in histologically negative lymph nodes requires further follow-up of the cohort.
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Affiliation(s)
- Jiri Slama
- General Teaching Hospital and 1st Medical School of Charles University, Department of Oncogynecology, Apolinarska 18, 128 00 Prague 2, Czech Republic.
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Slama J, Fischerova D, Pinkavova I, Zikan M, Cibula D. Human papillomavirus DNA presence in pelvic lymph nodes in cervical cancer. Int J Gynecol Cancer 2010; 20:126-32. [PMID: 20130513 DOI: 10.1111/igc.0b013e3181c01cf0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION This work intends to present a systematic overview of data that have been published so far with regard to methods used for tissue sampling and DNA testing and with regard to the prevalence of human papillomavirus (HPV) DNA in pelvic lymph nodes (LNs) and its prognostic significance. METHODS The HPV DNA status of LN in women with cervical cancer is being explored as a potential marker of "occult" metastases. Although the presence of HPV DNA in LN usually correlates with its metastatic involvement, there is always a subgroup of HPV-positive but histologically negative LNs. RESULTS The significance of HPV in negative LNs remains uncertain, although several studies have concluded that HPV is a risk factor of recurrence. CONCLUSIONS A small group size and a short follow-up are the main limitations for drawing any conclusion concerning prognostic significance of the presence of HPV DNA in LNs.
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Affiliation(s)
- Jiri Slama
- Department of Oncogynecology, General Teaching Hospital and 1st Medica School of Charles University, Apolinarska 18, 128 00 Prague 2, Czech Republic.
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