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Liu X, Fang C, Hu W, Su C, Xu F, Hu H, Li C. Postoperative clearance of high-risk human papillomavirus for patients with high-grade squamous intraepithelial lesion: Conization versus hysterectomy. Medicine (Baltimore) 2024; 103:e39564. [PMID: 39252222 PMCID: PMC11383495 DOI: 10.1097/md.0000000000039564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
To compare the clearance rate of high-risk human papillomavirus (HR-HPV) in patients with high-grade squamous intraepithelial lesion (HSIL) after 2 different treatments (conization vs hysterectomy), and investigate the influencing factors. A retrospective cohort was established in HSIL patients with HR-HPV infection treated with conization or hysterectomy from July 2020 to May 2022. Age matching (1:1) was conducted between conization group and hysterectomy group. Chi-square test and t-test were employed to compare baseline and clinical characteristics between the 2 groups (conization vs hysterectomy). In addition, univariate and multivariate logistic regression analyses were conducted to compare the influencing factors for HR-HPV clearance at 6 months after surgery. The HR-HPV clearance rates at 6 months were 70.6% and 73.8% in conization group and hysterectomy group in the matched groups, respectively (P = .755). Similarly, at 12 months, the clearance rates were 78.6% and 76.5% in the matched groups, respectively (P = .844). Considering different age groups among all patients, the HR-HPV clearance rates were 81.8%, 72.9%, 73.5%, and 53.6% in the 20 to 30-year, 31 to 40-year, 41 to 50-year and 51 to 60-year groups at 6 months, respectively, and the clearance rates were 87.5%, 80.6%, 84.5% and 52.9% at 12 months, respectively. For HSIL, the postoperative HPV clearance rates were similar between the 2 groups (conization vs hysterectomy), conization is enough to resect the lesion and eliminate HPV. In addition, we should pay attention to the postoperative HR-HPV status in the older population of the 2 groups.
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Affiliation(s)
- Xinglin Liu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Chunling Fang
- Department of Obstetrics and Gynecology, Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong, China
| | - Wenhao Hu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Chang Su
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Fan Xu
- Department of Obstetrics and Gynecology, Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong, China
| | - Huiquan Hu
- Department of Obstetrics and Gynecology, Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong, China
| | - Chengzhi Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Zhang L, Zheng Y, Lei L, Zhang X, Yang J, Zeng Y, Chen K. Development of a machine learning-based model for predicting positive margins in high-grade squamous intraepithelial lesion (HSIL) treatment by Cold Knife Conization(CKC): a single-center retrospective study. BMC Womens Health 2024; 24:332. [PMID: 38849836 PMCID: PMC11157760 DOI: 10.1186/s12905-024-03180-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/04/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVES This study aims to analyze factors associated with positive surgical margins following cold knife conization (CKC) in patients with cervical high-grade squamous intraepithelial lesion (HSIL) and to develop a machine-learning-based risk prediction model. METHOD We conducted a retrospective analysis of 3,343 patients who underwent CKC for HSIL at our institution. Logistic regression was employed to examine the relationship between demographic and pathological characteristics and the occurrence of positive surgical margins. Various machine learning methods were then applied to construct and evaluate the performance of the risk prediction model. RESULTS The overall rate of positive surgical margins was 12.9%. Independent risk factors identified included glandular involvement (OR = 1.716, 95% CI: 1.345-2.189), transformation zone III (OR = 2.838, 95% CI: 2.258-3.568), HPV16/18 infection (OR = 2.863, 95% CI: 2.247-3.648), multiple HR-HPV infections (OR = 1.930, 95% CI: 1.537-2.425), TCT ≥ ASC-H (OR = 3.251, 95% CI: 2.584-4.091), and lesions covering ≥ 3 quadrants (OR = 3.264, 95% CI: 2.593-4.110). Logistic regression demonstrated the best prediction performance, with an accuracy of 74.7%, sensitivity of 76.7%, specificity of 74.4%, and AUC of 0.826. CONCLUSION Independent risk factors for positive margins after CKC include HPV16/18 infection, multiple HR-HPV infections, glandular involvement, extensive lesion coverage, high TCT grades, and involvement of transformation zone III. The logistic regression model provides a robust and clinically valuable tool for predicting the risk of positive margins, guiding clinical decisions and patient management post-CKC.
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Affiliation(s)
- Lin Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Shashi District, 8 Hangkong Road, Jingzhou, Hubei, China
| | - Yahong Zheng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Shashi District, 8 Hangkong Road, Jingzhou, Hubei, China
| | - Lingyu Lei
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Shashi District, 8 Hangkong Road, Jingzhou, Hubei, China
| | - Xufeng Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Shashi District, 8 Hangkong Road, Jingzhou, Hubei, China
| | - Jing Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Shashi District, 8 Hangkong Road, Jingzhou, Hubei, China
| | - Yong Zeng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Shashi District, 8 Hangkong Road, Jingzhou, Hubei, China.
| | - Keming Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Shashi District, 8 Hangkong Road, Jingzhou, Hubei, China.
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Cassani C, Dominoni M, Pasquali MF, Gardella B, Spinillo A. The role of multiple high-risk human papillomavirus infection on the persistence recurrence of high-grade cervical lesions after standard treatment: A systematic review and a meta-analysis. Acta Obstet Gynecol Scand 2024; 103:1028-1035. [PMID: 38477097 PMCID: PMC11103134 DOI: 10.1111/aogs.14827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/19/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION The role of multiple high-risk human papillomavirus (HR-HPV) infections on the occurrence of persistence/recurrence of high-grade squamous intraepithelial lesion (HSIL) after conization/surgery for cervical intraepithelial neoplasia was evaluated. MATERIAL AND METHODS A systematic search of Pubmed/Medine, Scopus, Cochrane databases from inception to June 30, 2023 was performed. Three reviewers independently screened the abstracts of the selected studies and extracted data from full-text articles. The data were subsequently tabulated and compared for consistency. The bias associated with each included study was evaluated according to the OSQE method. PROSPERO registration number CRD42023433022. RESULTS Out of 1606 records screened, 22 full text articles met the inclusion criteria. A total of 8321 subjects treated (loop electrosurgical excision, laser or surgery) because of HSIL were followed-up and included in the meta-analysis. The pooled prevalence of overall persistence and/or recurrence was 17.6 (95% CI: 12.3-23.5) in multiple and 14.3 (95% CI: 10.1-19.2) in single HR-HPV infections detected shortly before or at surgery. The pooled rate of multiple HR-HPV infections was 25% (95% CI: 20.4-30). The odds ratio of histologically confirmed HSIL persistence and/or recurrence was significantly higher (OR: 1.38, 95% CI:1.08-1.75, p = 0.01, heterogeneity = 39%) among multiple than single HR-HPV infections. Increased risk of HSIL persistence/recurrence was more marked among studies with multiple HR-HPVs prevalence ≥25% (12 studies, N = 3476) (OR: 1.47, 95% CI: 1.18-1.84, heterogeneity = 0%) and in those evaluating true histologically confirmed recurrence after at least 6 months of negative follow-up (9 studies, N = 5073) (OR: 1.67, 95% CI: 1.17-2.37, heterogeneity = 37%). Multiple HR-HPVs infection detected during follow-up visits had no effect on the risk of recurrence although the number of included studies was small (4 studies, N = 1248) (OR: 0.98, 95% CI: 0.68-1.39, heterogeneity = 0%). The risk of bias was rated as high in 10 and low-moderate in 12 studies, respectively. In subgroup analysis, the risk of bias of the included studies (low/moderate vs. high), had a small, although not significant effect on the odds ratios of persistence/recurrence of HSIL (OR: 1.57, 95% CI: 1.23-2 for low-moderate risk of bias and OR: 1.06, 95% CI: 0.65-1.75 for high risk of bias; p-value for subgroup differences = 0.17). CONCLUSIONS Multiple HR-HPVs infections at the time of standard treatment of HSIL entail a small but significant increased risk of persistence/recurrence of HSIL and should be taken into account in the follow-up plan.
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Affiliation(s)
- Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric SciencesUniversity of PaviaPaviaItaly
- Department Obstetrics and GynecologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Mattia Dominoni
- Department of Clinical, Surgical, Diagnostic and Pediatric SciencesUniversity of PaviaPaviaItaly
- Department Obstetrics and GynecologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Marianna Francesca Pasquali
- Department of Clinical, Surgical, Diagnostic and Pediatric SciencesUniversity of PaviaPaviaItaly
- Department Obstetrics and GynecologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Barbara Gardella
- Department of Clinical, Surgical, Diagnostic and Pediatric SciencesUniversity of PaviaPaviaItaly
- Department Obstetrics and GynecologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Arsenio Spinillo
- Department of Clinical, Surgical, Diagnostic and Pediatric SciencesUniversity of PaviaPaviaItaly
- Department Obstetrics and GynecologyFondazione IRCCS Policlinico San MatteoPaviaItaly
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Peng H, Liu W, Jiang J, Du H. Extensive lesions and a positive cone margin are strong predictors of residual disease in subsequent hysterectomy following conization for squamous intraepithelial lesion grade 2 or 3 study design. BMC Womens Health 2023; 23:454. [PMID: 37641051 PMCID: PMC10464471 DOI: 10.1186/s12905-023-02568-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND This study aimed to determine the predictive factors for post-conization of residual disease in subsequent hysterectomy for cervical intraepithelial neoplasia grade 2 or 3. METHODS This retrospective study included 267 patients with histologically confirmed cervical intraepithelial neoplasia grade 2 or 3 who underwent hysterectomy within 7 months after conization. Clinical data (e.g., age, menopausal status, gravidity, parity, type of transformation zone, conization method) as well as pathological data pertaining to conization and hysterectomy were collected from medical records. A logistic regression model was used to analyze the relationship between the variables and risk of residual lesions in hysterectomy samples. RESULTS Overall, 70 (26.2%) patients had residual lesions in their hysterectomy specimens. Univariate analyses revealed that age ≥ 50 years (p=0.019), endocervical gland involvement(p=0.013), positive margin(p < 0.001), and involvement of 3-4 quadrants(p < 0.001) were risk factors for residual lesions. Conversely, postmenopausal status, gravidity ≥ 3, parity ≥ 2, loop electrosurgical excision procedure, and type III transformation zone were not risk factors for residual lesions. A positive margin(p < 0.001) and multiple-quadrant involvement(p < 0.001) were identified as independent risk factors for residual lesions on multivariate analysis. CONCLUSIONS Multiple-quadrant involvement and a positive cone margin were reliable predictive factors for residual disease. Total hysterectomy or repeated cervical conization should be considered for patients with these two risk factors. The identification of high-risk patients with extensive lesions by colposcopic examination before conization is indispensable, as it will enable surgeons to perform conization with consideration of risk factors and possibly improve the approach used for the excisional procedure. For high-risk patients, colposcope-guided cold-knife conization is preferred when resources permit.
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Affiliation(s)
- Hongfa Peng
- Department of Obstetrics and Gynecology, Second hospital of Hebei medical university, Shijiazhuang City, 050000, Hebei, China
| | - Wencan Liu
- Department of Obstetrics and Gynecology, Second hospital of Hebei medical university, Shijiazhuang City, 050000, Hebei, China
| | - Jingjing Jiang
- Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang City, 050051, Hebei, China.
| | - Hui Du
- Department of Obstetrics and Gynecology, Second hospital of Hebei medical university, Shijiazhuang City, 050000, Hebei, China.
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Kurihara S, Hamasaki Y, Onjo S, Nishiyama K, Nishida M. Hysterectomy through Minimally Invasive Surgery for Cervical High-grade Intraepithelial Neoplasia: Reassessment of the Specimens' Eligibility for Histological Examination. Gynecol Minim Invasive Ther 2023; 12:148-152. [PMID: 37807995 PMCID: PMC10553598 DOI: 10.4103/gmit.gmit_68_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives The objective was to investigate the microscopic artifacts made in the uterus of cervical high-grade squamous intraepithelial lesion (HSIL) resected by hysterectomy through minimally invasive (H-MI) procedures and to verify whether these specimens are suitable for histopathological assessment. Materials and Methods This single-center retrospective study analyzed 28 patients with cervical HSIL, consisting of 21 premenopausal and seven postmenopausal women, who underwent H-MI. The proportion of the cervical mucosa covered by intact surface epithelium (residual ratio [RR]) was measured on microscopically. Surgical margin's status was also verified. Results All cases developed detachment of the cervical surface epithelium to a varying extent. The RR was significantly higher in the premenopausal patients (median: 75.5%) than in the postmenopausal patients (median: 37.6%). Among the premenopausal patients, the RR was lower in the cases on whom uterine manipulator (UM) was used (median: 70.5%) than in the cases without UM use (median 92.7%). Among the 21 cases whose resected uterus contained HSIL, the vaginal resection margin was not assessable in three (14.2%) of the seven postmenopausal cases due to the artifact. Conclusion Although transvaginal manipulation of the uterus causes detachment of the cervical surface epithelium, H-MI for cervical HSIL provides an acceptable specimen for histological assessment in premenopausal patients, even if UM is used. In postmenopausal women, H-MI easily develops artifactual loss of cervical surface epithelium, sometimes providing an unfavorable specimen for microscopic assessment.
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Affiliation(s)
- Shuichi Kurihara
- Department of Obstetrics and Gynecology, Japanese Red Cross Fukuoka Hospital, Ogusu, Minami-Ku, Fukuoka, Japan
- Department of Obstetrics and Gynecology, Japanese Red Cross Matsuyama Hospital, Matsuyama, Ehime, Japan
| | - Yoichiro Hamasaki
- Department of Obstetrics and Gynecology, Japanese Red Cross Fukuoka Hospital, Ogusu, Minami-Ku, Fukuoka, Japan
| | - Sachiko Onjo
- Department of Obstetrics and Gynecology, Japanese Red Cross Fukuoka Hospital, Ogusu, Minami-Ku, Fukuoka, Japan
| | - Kenichi Nishiyama
- Department of Pathology, Japanese Red Cross Fukuoka Hospital, Ogusu, Minami-Ku, Fukuoka, Japan
| | - Makoto Nishida
- Department of Obstetrics and Gynecology, Japanese Red Cross Fukuoka Hospital, Ogusu, Minami-Ku, Fukuoka, Japan
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Clinical predictors of residual disease in hysterectomy following a loop electrosurgical excision procedure for cervical intraepithelial neoplasia grade 3. BMC Pregnancy Childbirth 2022; 22:971. [PMID: 36575366 PMCID: PMC9793502 DOI: 10.1186/s12884-022-05281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/05/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To investigate the predictors of residual disease in a hysterectomy following a loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN) 3. METHODS This retrospective study identified 421 patients with histologically confirmed CIN 3 who underwent LEEP and subsequently had a hysterectomy within 6 months. The clinical data included age, parity, type of transformation zone, cytology results, human papillomavirus (HPV) genotype test, endocervical curettage (ECC), and pathological data of LEEP and hysterectomy were obtained from the medical records. A logistic regression model was used to analyze the relationship between the variables and the risk of residual disease in the hysterectomy samples. RESULTS 186 (44.18%) patients had residual disease in the hysterectomy specimens. The predictive markers of residual disease following LEEP included positive ECC, positive margin of the samples from LEEP, type II or III transformation zone, HPV16 and HPV18 infection, and other high-risk HPV. HPV-18 positivity (OR, 7.13; 95% CI, 3.49 to 14.56; p < 0.001) and type III transformation zone (OR, 6.37; 95% CI, 2.91 to 13.94; p < 0.001) were the most indicative of residual disease following LEEP. CONCLUSION Positive high-risk HPV, particularly HPV18, positive ECC, the positive margin of specimens from LEEP, and type II or III transformation zone were reliable prognostic markers of residual disease following a LEEP for CIN 3.
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Clubb JHA, Kudling TV, Heiniö C, Basnet S, Pakola S, Cervera Carrascón V, Santos JM, Quixabeira DCA, Havunen R, Sorsa S, Zheng V, Salo T, Bäck L, Aro K, Tulokas S, Loimu V, Hemminki A. Adenovirus Encoding Tumor Necrosis Factor Alpha and Interleukin 2 Induces a Tertiary Lymphoid Structure Signature in Immune Checkpoint Inhibitor Refractory Head and Neck Cancer. Front Immunol 2022; 13:794251. [PMID: 35355980 PMCID: PMC8959099 DOI: 10.3389/fimmu.2022.794251] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/14/2022] [Indexed: 12/24/2022] Open
Abstract
Immune checkpoint inhibitors (ICI) have provided significant improvement in clinical outcomes for some patients with solid tumors. However, for patients with head and neck cancer, the response rate to ICI monotherapy remains low, leading to the exploration of combinatorial treatment strategies. In this preclinical study, we use an oncolytic adenovirus (Ad5/3) encoding hTNFα and hIL-2 and non-replicate adenoviruses (Ad5) encoding mTNFα and mIL-2 with ICI to achieve superior tumor growth control and improved survival outcomes. The in vitro effect of Ad5/3-E2F-D24-hTNFa-IRES-hIL-2 was characterized through analyses of virus replication, transgene expression and lytic activity using head and neck cancer patient derived cell lines. Mouse models of ICI naïve and refractory oral cavity squamous cell carcinoma were established to evaluate the local and systemic anti-tumor immune response upon ICI treatment with or without the non-replicative adenovirus encoding mTNFα and mIL-2. We delineated the mechanism of action by measuring the metabolic activity and effector function of CD3+ tumor infiltrating lymphocytes (TIL) and transcriptomic profile of the CD45+ tumor immune compartment. Ad5/3-E2F-D24-hTNFa-IRES-hIL-2 demonstrated robust replicative capability in vitro across all head and neck cell lines screened through potent lytic activity, E1a and transgene expression. In vivo, in both ICI naïve and refractory models, we observed improvement to tumor growth control and long-term survival when combining anti-PD-1 or anti-PD-L1 with the non-replicative adenovirus encoding mTNFα and mIL-2 compared to monotherapies. This observation was verified by striking CD3+ TIL derived mGranzyme b and interferon gamma production complemented by increased T cell bioenergetics. Notably, interrogation of the tumor immune transcriptome revealed the upregulation of a gene signature distinctive of tertiary lymphoid structure formation upon treatment of murine anti-PD-L1 refractory tumors with non-replicative adenovirus encoding mTNFα and mIL-2. In addition, we detected an increase in anti-tumor antibody production and expansion of the memory T cell compartment in the secondary lymphoid organs. In summary, a non-replicative adenovirus encoding mTNFα and mIL-2 potentiates ICI therapy, demonstrated by improved tumor growth control and survival in head and neck tumor-bearing mice. Moreover, the data reveals a potential approach for inducing tertiary lymphoid structure formation. Altogether our results support the clinical potential of combining this adenovirotherapy with anti-PD-1 or anti-PD-L1.
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Affiliation(s)
- James H. A. Clubb
- Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- TILT Biotherapeutics Ltd, Helsinki, Finland
- Translational Immunology Research Program (TRIMM), Research Program Unit (RPU), University of Helsinki, Helsinki, Finland
| | - Tatiana V. Kudling
- Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Translational Immunology Research Program (TRIMM), Research Program Unit (RPU), University of Helsinki, Helsinki, Finland
| | - Camilla Heiniö
- Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Translational Immunology Research Program (TRIMM), Research Program Unit (RPU), University of Helsinki, Helsinki, Finland
| | - Saru Basnet
- Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Translational Immunology Research Program (TRIMM), Research Program Unit (RPU), University of Helsinki, Helsinki, Finland
| | - Santeri Pakola
- Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Translational Immunology Research Program (TRIMM), Research Program Unit (RPU), University of Helsinki, Helsinki, Finland
| | - Víctor Cervera Carrascón
- Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- TILT Biotherapeutics Ltd, Helsinki, Finland
- Translational Immunology Research Program (TRIMM), Research Program Unit (RPU), University of Helsinki, Helsinki, Finland
| | - João Manuel Santos
- Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- TILT Biotherapeutics Ltd, Helsinki, Finland
- Translational Immunology Research Program (TRIMM), Research Program Unit (RPU), University of Helsinki, Helsinki, Finland
| | - Dafne C. A. Quixabeira
- Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Translational Immunology Research Program (TRIMM), Research Program Unit (RPU), University of Helsinki, Helsinki, Finland
| | - Riikka Havunen
- Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- TILT Biotherapeutics Ltd, Helsinki, Finland
- Translational Immunology Research Program (TRIMM), Research Program Unit (RPU), University of Helsinki, Helsinki, Finland
| | - Suvi Sorsa
- Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- TILT Biotherapeutics Ltd, Helsinki, Finland
- Translational Immunology Research Program (TRIMM), Research Program Unit (RPU), University of Helsinki, Helsinki, Finland
| | - Vincent Zheng
- Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Translational Immunology Research Program (TRIMM), Research Program Unit (RPU), University of Helsinki, Helsinki, Finland
| | - Tuula Salo
- Translational Immunology Research Program (TRIMM), Research Program Unit (RPU), University of Helsinki, Helsinki, Finland
- Department of Oral and Maxillofacial Diseases, Clinicum, University of Helsinki, Helsinki, Finland
- Cancer and Translational Medicine Research Unit, University of Oulu, Oulu, Finland
- Oulu University Central Hospital, Oulu, Finland
- Department of Oncology, Comprehensive Cancer Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Leif Bäck
- Department of Oncology, Comprehensive Cancer Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Katri Aro
- Department of Oncology, Comprehensive Cancer Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sanni Tulokas
- Department of Oncology, Comprehensive Cancer Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Venla Loimu
- Department of Oncology, Comprehensive Cancer Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- TILT Biotherapeutics Ltd, Helsinki, Finland
- Translational Immunology Research Program (TRIMM), Research Program Unit (RPU), University of Helsinki, Helsinki, Finland
- Department of Oncology, Comprehensive Cancer Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Wang X, Xu J, Gao Y, Qu P. Necessity for subsequent surgery in women of child-bearing age with positive margins after conization. BMC Womens Health 2021; 21:191. [PMID: 33962590 PMCID: PMC8103630 DOI: 10.1186/s12905-021-01329-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/22/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND 20-25% of women with high-grade cervical intraepithelial neoplasias (HSIL) have residual lesions after conization. The state of the margin is generally considered to be a risk factor for recurrence or persistent lesions. Predictors of positive margins and residual lesions need to be identified. A design for postoperative management and avoidance of overtreatment needs to be provided, especially for women of child-bearing age. METHODS This study was a retrospective analysis of 1309 women of child-bearing age with HSIL, who underwent cold knife conization (CKC). Age, gravidity, parity, human papillomavirus (HPV) species, cytology, transformation zone type, results of endocervical curettage (ECC), quadrant involvement, glandular involvement, and Cervical Intraepithelial Neoplasia (CIN) grade were analyzed. Among those with positive margins, 245 patients underwent secondary surgery within three months, including CKC, a loop electrosurgical excision procedure, and total hysterectomy. Risk factors for positive margins and residual lesions were assessed. RESULTS There was no significant difference in age, gravidity, parity, glandular involvement, and CIN grade between the two groups (P > 0.3). There was a significant difference in HPV species, cytology, ECC results, and quadrant involvement (P < 0.002). Multivariate analysis showed a major cytology abnormality, high-risk HPV infection, type III transformation zone, positive ECC result, and multiple quadrant involvement were independent risk factors for positive margins and residual lesions (P < 0.02). Age > 35 years was also a risk factor for residual lesions (P < 0.03). CONCLUSION High-risk women should be treated appropriately considering fertility. Patients with positive margins should be managed uniquely. Surgery for women without fertility may be appropriate. Close follow-up is necessary for women who have fertility requirements or are unwilling to undergo subsequent surgery if they have no risk factors, especially women < 35 years.
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Affiliation(s)
- Xinmei Wang
- Clinical College of Central Gynecology and Obstetrics, Tianjin Medical University, Tianjin, 300070, China.,Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, 300100, China
| | - Juan Xu
- Clinical College of Central Gynecology and Obstetrics, Tianjin Medical University, Tianjin, 300070, China
| | - Yang Gao
- Clinical College of Central Gynecology and Obstetrics, Tianjin Medical University, Tianjin, 300070, China
| | - Pengpeng Qu
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, 300100, China.
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Rizzuto I, Sampson V, Liou NS, Evans H. Early surgical treatment versus observational management for cervical intraepithelial neoplasia 2 (CIN2). Hippokratia 2020. [DOI: 10.1002/14651858.cd013807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ivana Rizzuto
- Department of Gynaecological Oncology; Royal Brisbane and Women’s Hospital; Brisbane Australia
| | - Victoria Sampson
- Obstetrics and Gynaecology; Royal Free London NHS Foundation Trust; London UK
| | - Natasha S Liou
- Obstetrics and Gynaecology; Royal Free London NHS Foundation Trust; London UK
| | - Heather Evans
- Obstetrics and Gynaecology; Royal Free London NHS Foundation Trust; London UK
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10
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Zhao Y, Wang QM, Yao LT, Han X. Effect of paiteling on the alteration of persistent HR-HPV infection after panhysterectomy. EUR J INFLAMM 2018. [DOI: 10.1177/2058739218819172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
This study aims to determine the effect of paiteling by placing a vaginal stump on the outcome of persistent high-risk human papillomavirus (HR-HPV) infection after hysterectomy for cervical intraepithelial neoplasia (CIN). From January 2013 to December 2015, 125 patients were enrolled in the study. These patients were divided into groups, according to patient’s preference. There were 55 patients in the paiteling group, while there were 70 patients in the control group. At the end of the third and ninth month, Thinprep cytology test (TCT) and human papillomavirus (HPV) typing were reviewed to determine the changes in HR-HPV and its complications. The negative conversion rates of these two groups were observed. Patients in the control group were observed and followed up without treatment. At the third month after treatment, HPV negative rates were 83.64% and 34.29% in the paiteling group and control group, respectively (χ2 = 30.444, P < 0.01). In the ninth month, the rate of HPV negative conversion was 90.91% in the paiteling group and 48.57% in the control group (χ2 = 25.047, P < 0.01). The difference between the two groups was statistically significant, and patients in both groups had no obvious adverse reactions. Paiteling irrigation at the vaginal stump can accelerate the positive-to-negative conversion of HR-HPV infection after panhysterectomy.
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Affiliation(s)
- Ye Zhao
- Department of Gynecology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Qiu-Man Wang
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Li-Ting Yao
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Xiao Han
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
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11
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Morrow MP, Kraynyak KA, Sylvester AJ, Dallas M, Knoblock D, Boyer JD, Yan J, Vang R, Khan AS, Humeau L, Sardesai NY, Kim JJ, Plotkin S, Weiner DB, Trimble CL, Bagarazzi ML. Clinical and Immunologic Biomarkers for Histologic Regression of High-Grade Cervical Dysplasia and Clearance of HPV16 and HPV18 after Immunotherapy. Clin Cancer Res 2017; 24:276-294. [PMID: 29084917 DOI: 10.1158/1078-0432.ccr-17-2335] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/04/2017] [Accepted: 10/24/2017] [Indexed: 02/06/2023]
Abstract
Purpose: As previously reported, treatment of high-grade cervical dysplasia with VGX-3100 resulted in complete histopathologic regression (CR) concomitant with elimination of HPV16/18 infection in 40.0% of VGX-3100-treated patients compared with only 14.3% in placebo recipients in a randomized phase IIb study. Here, we identify clinical and immunologic characteristics that either predicted or correlated with therapeutic benefit from VGX-3100 to identify parameters that might guide clinical decision-making for this disease.Experimental Design: We analyzed samples taken from cervical swabs, whole blood, and tissue biopsies/resections to determine correlates and predictors of treatment success.Results: At study entry, the presence of preexisting immunosuppressive factors such as FoxP3 and PD-L1 in cervical lesions showed no association with treatment outcome. The combination of HPV typing and cervical cytology following dosing was predictive for both histologic regression and elimination of detectable virus at the efficacy assessment 22 weeks later (negative predictive value 94%). Patients treated with VGX-3100 who had lesion regression had a statistically significant >2-fold increase in CD137+perforin+CD8+ T cells specific for the HPV genotype causing disease. Increases in cervical mucosal CD137+ and CD103+ infiltrates were observed only in treated patients. Perforin+ cell infiltrates were significantly increased >2-fold in cervical tissue only in treated patients who had histologic CR.Conclusions: Quantitative measures associated with an effector immune response to VGX-3100 antigens were associated with lesion regression. Consequently, these analyses indicate that certain immunologic responses associate with successful resolution of HPV-induced premalignancy, with particular emphasis on the upregulation of perforin in the immunotherapy-induced immune response. Clin Cancer Res; 24(2); 276-94. ©2017 AACR.
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Affiliation(s)
| | | | | | | | | | - Jean D Boyer
- Inovio Pharmaceuticals, Plymouth Meeting, Pennsylvania
| | - Jian Yan
- Inovio Pharmaceuticals, Plymouth Meeting, Pennsylvania
| | - Russell Vang
- Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Amir S Khan
- Inovio Pharmaceuticals, Plymouth Meeting, Pennsylvania
| | | | | | - J Joseph Kim
- Inovio Pharmaceuticals, Plymouth Meeting, Pennsylvania
| | - Stanley Plotkin
- The University of Pennsylvania, Philadelphia, Pennsylvania.,Vaxconsult, Doylestown, Pennsylvania
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12
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Ye J, Cheng B, Cheng YF, Yao YL, Xie X, Lu WG, Cheng XD. Prognostic value of human papillomavirus 16/18 genotyping in low-grade cervical lesions preceded by mildly abnormal cytology. J Zhejiang Univ Sci B 2017; 18:249-255. [PMID: 28271660 DOI: 10.1631/jzus.b1600473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Histological low-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia grade 1 (LSIL/CIN1) preceded by normal or mildly abnormal cytology is recommended for conservative follow-up, with no separated management. In this study, we assessed the triage value of human papillomavirus (HPV) 16/18 genotyping in 273 patients with LSIL/CIN1. HPV16/18 genotyping was performed at baseline and follow-up was at 6-monthly intervals for up to 2 years. At each follow-up, women positive for cytology or high-risk HPV (hrHPV) were referred for colposcopy. Enrollment cytology, HPV16/18 genotyping, and questionnaire-obtained factors were linked to the 2-year cumulative progression rate. Univariate and multivariate analyses were performed taking into account time-to-event with Cox proportional hazard regression. The results showed that 190 cases (69.6%) regressed, 37 (13.6%) persisted, and 46 (16.8%) progressed. HPV16/18 positivity (hazard ratio (HR), 2.708; 95% confidence interval (CI), 1.432-5.121; P=0.002) is significantly associated with higher 2-year cumulative progression rate. Sub-analysis by enrollment cytology and age restricted the positive association among patients preceded by mildly abnormal cytology and aged 30 years or older. Immediate treatment is a rational recommendation for the high-risk subgroup, when good compliance is not assured.
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Affiliation(s)
- Jing Ye
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Bei Cheng
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Yi-Fan Cheng
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Ye-Li Yao
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Xing Xie
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Wei-Guo Lu
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Xiao-Dong Cheng
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
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13
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Efficacy of loop electrosurgical excision procedure with cold coagulation for treating cervical intraepithelial neoplasia: A two center cohort study. Obstet Gynecol Sci 2017; 60:200-206. [PMID: 28344962 PMCID: PMC5364103 DOI: 10.5468/ogs.2017.60.2.200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/30/2016] [Accepted: 10/05/2016] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of loop electrosurgical excision procedure (LEEP) combined with cold coagulation for treating cervical intraepithelial neoplasia (CIN). METHODS We reviewed clinic-pathologic data of 498 patients treated with LEEP alone (n=354), and LEEP combined with cold coagulation (n=144) between January 2000 and December 2011. After LEEP, we followed up all patients by using Papanicolaou smear and human papillomavirus (HPV) test, and evaluated abnormal cervical cytology-free interval and high-risk HPV infection-free interval. Moreover, we investigated independent factors affecting abnormal cervical cytology or high-risk HPV infection after LEEP. RESULTS Abnormal cervical cytology-free interval was longer in patients treated with LEEP combined with cold coagulation than in those treated with LEEP alone (mean, 92.4 vs. 84.4 months; P=0.01), and patients treated with LEEP combined with cold coagulation also showed longer high-risk HPV infection-free interval than those treated with LEEP alone (mean, 87.6 vs. 59.1 months; P=0.01). Moreover, CIN 3 and cold coagulation were factors affecting abnormal cervical cytology after LEEP (adjusted hazard ratios, 1.90 and 0.61; 95% confidence intervals, 1.27 to 2.84 and 0.39 to 0.96), and CIN 3, positive deep cervical margin and cold coagulation were also factors affecting high-risk HPV infection after LEEP (adjusted hazard ratios, 2.07, 4.11, and 0.64; 95% confidence intervals, 1.38 to 3.08, 1.63 to 10.39, and 0.43 to 0.96). When we performed subgroup analyses for patients with CIN 2 or CIN 3, the result were similar. CONCLUSION LEEP combined with cold coagulation may be more effective for treating CIN than LEEP alone. Moreover, cold coagulation may decrease the risk of potential of recurrence after LEEP.
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14
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Morrow MP, Kraynyak KA, Sylvester AJ, Shen X, Amante D, Sakata L, Parker L, Yan J, Boyer J, Roh C, Humeau L, Khan AS, Broderick K, Marcozzi-Pierce K, Giffear M, Lee J, Trimble CL, Kim JJ, Sardesai NY, Weiner DB, Bagarazzi ML. Augmentation of cellular and humoral immune responses to HPV16 and HPV18 E6 and E7 antigens by VGX-3100. MOLECULAR THERAPY-ONCOLYTICS 2016; 3:16025. [PMID: 28054033 PMCID: PMC5147865 DOI: 10.1038/mto.2016.25] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/03/2016] [Indexed: 12/24/2022]
Abstract
We have previously demonstrated the immunogenicity of VGX-3100, a multicomponent DNA immunotherapy for the treatment of Human Papillomavirus (HPV)16/18-positive CIN2/3 in a phase 1 clinical trial. Here, we report on the ability to boost immune responses with an additional dose of VGX-3100. Patients completing our initial phase 1 trial were offered enrollment into a follow on trial consisting of a single boost dose of VGX-3100. Data show both cellular and humoral immune responses could be augmented above pre-boost levels, including the induction of interferon (IFN)γ production, tumor necrosis factor (TNF)α production, CD8+ T cell activation and the synthesis of lytic proteins. Moreover, observation of antigen-specific regulation of immune-related gene transcripts suggests the induction of a proinflammatory response following the boost. Analysis of T cell receptor (TCR) sequencing suggests the localization of putative HPV-specific T cell clones to the cervical mucosa, which underscores the putative mechanism of action of lesion regression and HPV16/18 elimination noted in our double-blind placebo-controlled phase 2B trial. Taken together, these data indicate that VGX-3100 drives the induction of robust cellular and humoral immune responses that can be augmented by a fourth "booster" dose. These data could be important in the scope of increasing the clinical efficacy rate of VGX-3100.
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Affiliation(s)
| | | | | | - Xuefei Shen
- Inovio Pharmaceuticals , Plymouth Meeting, Pennsylvania, USA
| | - Dinah Amante
- Inovio Pharmaceuticals , Plymouth Meeting, Pennsylvania, USA
| | - Lindsay Sakata
- Inovio Pharmaceuticals , Plymouth Meeting, Pennsylvania, USA
| | - Lamar Parker
- Unified Women's Clinical Research , Winston-Salem, North Carolina, USA
| | - Jian Yan
- Inovio Pharmaceuticals , Plymouth Meeting, Pennsylvania, USA
| | - Jean Boyer
- Inovio Pharmaceuticals , Plymouth Meeting, Pennsylvania, USA
| | - Christian Roh
- Inovio Pharmaceuticals , Plymouth Meeting, Pennsylvania, USA
| | - Laurent Humeau
- Inovio Pharmaceuticals , Plymouth Meeting, Pennsylvania, USA
| | - Amir S Khan
- Inovio Pharmaceuticals , Plymouth Meeting, Pennsylvania, USA
| | - Kate Broderick
- Inovio Pharmaceuticals , Plymouth Meeting, Pennsylvania, USA
| | | | - Mary Giffear
- Inovio Pharmaceuticals , Plymouth Meeting, Pennsylvania, USA
| | - Jessica Lee
- Inovio Pharmaceuticals , Plymouth Meeting, Pennsylvania, USA
| | | | - J Joseph Kim
- Inovio Pharmaceuticals , Plymouth Meeting, Pennsylvania, USA
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15
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Rossi V, Lispi M, Longobardi S, Mattei M, Di Rella F, Salustri A, De Felici M, Klinger FG. LH prevents cisplatin-induced apoptosis in oocytes and preserves female fertility in mouse. Cell Death Differ 2016; 24:72-82. [PMID: 27689876 PMCID: PMC5260508 DOI: 10.1038/cdd.2016.97] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 01/09/2023] Open
Abstract
Premature ovarian failure and female infertility are frequent side effects of anticancer therapies, owing to the extreme sensitivity of the ovarian reserve oocytes to the damaging effects of irradiation and chemotherapy on DNA. We report here a robust protective effect of luteinizing hormone (LH) on the primordial follicle pool of prepubertal ovaries against the cisplatin (Cs)-induced apoptosis. In vitro LH treatment of prepubertal ovarian fragments generated anti-apoptotic signals by a subset of ovarian somatic cells expressing LH receptor (LHR) through cAMP/PKA and Akt pathways. Such signals, reducing the oocyte level of pro-apoptotic TAp63 protein and favoring the repair of the Cs-damaged DNA in the oocytes, prevented their apoptosis. Noteworthy, in vivo administration to prepubertal female mice of a single dose of LH together with Cs inhibited the depletion of the primordial follicle reserve caused by the drug and preserved their fertility in reproductive age, preventing significant alteration in the number of pregnancy and of delivered pups. In conclusion, these findings establish a novel ovoprotective role for LH and further support the very attracting prospective to use physiological 'fertoprotective' approaches for preventing premature infertility and risks linked to precocious menopause in young patients who survived cancer after chemotherapy.
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Affiliation(s)
- Valerio Rossi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Monica Lispi
- Medical Affair Department Fertility TA, Merck-Serono SAS, Rome, Italy
| | | | - Maurizio Mattei
- STA, Department of Biology, University of Rome 'Tor Vergata', Rome, Italy
| | - Francesca Di Rella
- UOC Oncologia Medica Senologica, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale, Naples, Italy
| | - Antonietta Salustri
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Massimo De Felici
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesca G Klinger
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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16
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Chen H, Liu X, Xu L. Incisal margin condition after LEEP for cervical intraepithelial neoplasia patients and prognosis. Exp Ther Med 2016; 12:1019-1021. [PMID: 27446314 PMCID: PMC4950641 DOI: 10.3892/etm.2016.3338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/11/2016] [Indexed: 12/25/2022] Open
Abstract
The aim of the study was to examine the relationship between incisal condition after loop electrosurgical excision procedure (LEEP) operation for cervical intraepithelial neoplasia (CIN) patients and prognosis. A study of high-risk incisal margin positive cases was also performed. We compared the differences in the prognosis of the 1-year follow-up visit in the 120 CIN patients admitted to the hospital during the period from April 2013 to April 2014. A total of 43 cases of positive incisal margin (35.8%), and 77 negative cases were included in the study. The differences in age, course of disease, and CIN level between the two groups showed no statistical significance (P>0.05). In the positive group, the positive ratio was significantly higher than that of the negative group (P<0.05). The positive incisal margin showed a significant positive correlation with human papillomavirus (HPV) positivity (r=0.327, P=0.035). The condition of most patients with positive incisal margin and HPV was critical, which was followed by positive incisal margin and negative HPV. The patients with the best prognosis were those with significant negative incisal margin as well as HPV (P<0.05). In conclusion, the positive incisal margin after LEEP operation was associated with relapse of the disease. Thus, considering the HPV test into consideration is valuable for the prognosis of the disease.
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Affiliation(s)
- Hong Chen
- Department of Gynaecology, Binzhou City Center Hospital, Binzhou, Shandong 251700, P.R. China
| | - Xiufeang Liu
- Department of Science and Education, Binzhou City Center Hospital, Binzhou, Shandong 251700, P.R. China
| | - Lina Xu
- Department of Gynaecology, Jining No. 1 People's Hospital, Jining, Shandong 272111, P.R. China
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17
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Turner TB, Huh WK. The role of human papillomavirus testing after treatment for high-grade cervical dysplasia. J Gynecol Oncol 2015; 27:e9. [PMID: 26676385 PMCID: PMC4695459 DOI: 10.3802/jgo.2016.27.e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Taylor B Turner
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Warner K Huh
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
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