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Welsh EF, Andrus EC, Sandler CB, Moravek MB, Stroumsa D, Kattari SK, Walline HM, Goudsmit CM, Brouwer AF. Cervicovaginal and Anal Self-Sampling for Human Papillomavirus Testing in a Transgender and Gender Diverse Population Assigned Female at Birth: Comfort, Difficulty, and Willingness to Use. LGBT Health 2024. [PMID: 38574315 DOI: 10.1089/lgbt.2023.0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Purpose: Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face numerous barriers to preventive care, including for cervical cancer screening. At-home human papillomavirus (HPV) testing may expand access to cervical cancer screening for TGD people AFAB. This study assessed the perceptions of TGD individuals AFAB who self-collected cervicovaginal and anal samples. Methods: We recruited TGD individuals AFAB to collect cervicovaginal and anal specimens at home using self-sampling for HPV testing, and individuals reported their perceptions of self-sampling. Associations between demographic and health characteristics and each of comfort of use, ease of use, and willingness to use self-sampling were estimated using robust Poisson regression. Results: Of 137 consenting participants, 101 completed the sample collection and the surveys. The majority of participants reported that the cervicovaginal self-swab was not uncomfortable (68.3%) and not difficult to use (86.1%), and nearly all (96.0%) were willing to use the swab in the future. Fewer participants found the anal swab to not be uncomfortable (47.5%), but most participants still found the anal swab to not be difficult to use (70.2%) and were willing to use the swab in the future (89.1%). Participants were more willing to use either swab if they had not seen a medical professional in the past year. Conclusions: TGD individuals AFAB were willing to use and preferred self-sampling methods for cervicovaginal and anal HPV testing. Developing clinically approved self-sampling options for HPV testing could expand access to cancer screening for TGD populations.
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Affiliation(s)
- Erin F Welsh
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily C Andrus
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Claire B Sandler
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Molly B Moravek
- Department of Obstetrics and Gynecology, Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Daphna Stroumsa
- Department of Obstetrics and Gynecology, Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Shanna K Kattari
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
- Department of Women's and Gender Studies, University of Michigan, Ann Arbor, Michigan, USA
| | - Heather M Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Andrew F Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
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McIntosh RD, Andrus EC, Walline HM, Sandler CB, Goudsmit CM, Moravek MB, Stroumsa D, Kattari SK, Brouwer AF. Prevalence and Determinants of Cervicovaginal, Oral, and Anal Human Papillomavirus Infection in a Population of Transgender and Gender Diverse People Assigned Female at Birth. LGBT Health 2024. [PMID: 38530059 DOI: 10.1089/lgbt.2023.0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Purpose: The human papillomavirus (HPV) causes cervicovaginal, oral, and anogenital cancer, and cervical cancer screening options include HPV testing of a clinician-collected sample. Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face many barriers to preventive care, including cancer screening. Self-sampling options may increase access and participation in HPV testing and cancer screening. This study estimated the prevalence of HPV in self-collected cervicovaginal, oral, and anal samples from Midwestern TGD individuals AFAB. Methods: We recruited TGD individuals AFAB for an observational study, mailing them materials to self-collect cervicovaginal, oral, and anal samples at home. We tested samples for high-risk (HR; 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) and other HPV genotypes (6, 11, 66, 68, 73, 90) using a polymerase chain reaction mass array test. Prevalence ratios for HPV infection at each site as a function of participant characteristics were estimated in log-binomial models. Results: Out of 137 consenting participants, 102 completed sample collection. Among those with valid tests, 8.8% (HR = 6.6%; HPV 16/18 = 3.3%) were positive for oral HPV, 30.5% (HR = 26.8%; HPV 16/18 = 9.7%) for cervicovaginal HPV, and 39.6% (HR = 33.3%; HPV 16/18 = 8.3%) for anal HPV. A larger fraction of oral (71.4%) than anal infections (50.0%) were concordant with a cervicovaginal infection of the same type. Conclusions: We detected HR cervicovaginal, oral, and anal HPV in TGD people AFAB. It is essential that we reduce barriers to cancer screening for TGD populations, such as through the development of a clinically approved self-screening HPV test.
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Affiliation(s)
- Ryan D McIntosh
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily C Andrus
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Heather M Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Claire B Sandler
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Molly B Moravek
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Daphna Stroumsa
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Shanna K Kattari
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
- Department of Women's and Gender Studies, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew F Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
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McIntosh RD, Andrus EC, Walline HM, Sandler CB, Goudsmit CM, Moravek MB, Stroumsa D, Kattari SK, Brouwer AF. Prevalence and determinants of cervicovaginal, oral, and anal HPV infection in a population of transgender and gender diverse people assigned female at birth. medRxiv 2023:2023.08.15.23294129. [PMID: 37645745 PMCID: PMC10462201 DOI: 10.1101/2023.08.15.23294129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Introduction HPV causes oral, cervicovaginal, and anogenital cancer, and cervical cancer screening options include HPV testing of a physician-collected sample. Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face discrimination and stigma in many healthcare settings; are believed to be a lower risk for cervical cancer by many physicians; are less likely to be up to date on preventive health care services such as pelvic health exams; and are more likely to have inadequate results from screening tests. Self-sampling options may increase access and participation in HPV testing and cancer screening. Methods We recruited 137 TGD individuals AFAB for an observational study, mailing them a kit to self-collect cervicovaginal, oral, and anal samples at home. We tested samples for HPV genotypes 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73 and 90 using a PCR mass array test. Results 102 participants completed the study. Among those with valid tests, 8.8% were positive for oral HPV, 30.5% were positive for cervicovaginal HPV, and 39.6% were positive for anal HPV. A large fraction of anal (50.0%) and oral (71.4%) infections were concordant with a cervicovaginal infection of the same type. Conclusions HPV infection in TGD people AFAB may be just as high, if not higher, than in cisgender women. It is essential that we reduce barriers to cancer screening for TGD populations, such as through the development of a clinically approved self-screening HPV test.
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Affiliation(s)
- Ryan D. McIntosh
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Emily C. Andrus
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Heather M. Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | - Claire B. Sandler
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | | | - Molly B. Moravek
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Daphna Stroumsa
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Shanna K. Kattari
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
- Department of Women’s and Gender Studies, University of Michigan, Ann Arbor, MI, United States
| | - Andrew F. Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
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Welsh EF, Andrus EC, Sandler CB, Moravek MB, Stroumsa D, Kattari SK, Walline HM, Goudsmit CM, Brouwer AF. Cervicovaginal and anal self-sampling for HPV testing in a transgender and gender diverse population assigned female at birth: comfort, difficulty, and willingness to use. medRxiv 2023:2023.08.15.23294132. [PMID: 37645965 PMCID: PMC10462238 DOI: 10.1101/2023.08.15.23294132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face numerous barriers to preventive care, including for HPV and cervical cancer screening. Self-sampling options may expand access to HPV testing for TGD people AFAB. Methods We recruited TGD individuals AFAB to collect cervicovaginal and anal specimens at-home using self-sampling for HPV testing, and individuals reported their perceptions of self-sampling. Associations between demographic and health characteristics and each of comfort of use, ease of use, and willingness to use self-sampling were estimated using robust Poisson regression. Results The majority of the 101 participants who completed the study reported that the cervicovaginal self-swab was not uncomfortable (68.3%) and not difficult to use (86.1%), and nearly all (96.0%) were willing to use the swab in the future. Fewer participants found the anal swab to not be uncomfortable (47.5%), but most participants still found the anal swab to not be difficult to use (70.2%) and were willing to use the swab in the future (89.1%). Participants were more willing to use either swab if they had not seen a medical professional in the past year. About 70% of participants who reported negative experiences with either self-swab were still willing to use that swab in the future. Conclusions TGD AFAB individuals were willing to use and preferred self-sampling methods for cervicovaginal and anal HPV testing. Developing clinically approved self-sampling options for cancer screening could expand access to HPV screening for TGD AFAB populations.
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Affiliation(s)
- Erin F Welsh
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Emily C. Andrus
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Claire B. Sandler
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Molly B. Moravek
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Daphna Stroumsa
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Shanna K. Kattari
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
- Department of Women’s and Gender Studies, University of Michigan, Ann Arbor, MI, United States
| | - Heather M. Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | | | - Andrew F. Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
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Brouwer AF, Campredon LP, Walline HM, Marinelli BM, Goudsmit CM, Thomas TB, Delinger RL, Lau YK, Andrus EC, Yost ML, McCloskey JK, Sullivan TS, Mortensen AS, Huang S, Murphy K, Cheng B, Stanek K, Nair T, Carey TE, Meza R, Eisenberg MC. Prevalence and determinants of oral and cervicogenital HPV infection: Baseline analysis of the Michigan HPV and Oropharyngeal Cancer (MHOC) cohort study. PLoS One 2022; 17:e0268104. [PMID: 35576195 PMCID: PMC9109914 DOI: 10.1371/journal.pone.0268104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
We determined baseline oral and cervicogenital human papillomavirus (HPV) prevalence and determinants of infection in the Michigan HPV and Oropharyngeal Cancer (MHOC) study. We enrolled 394 college-age and older participants of both sexes in Ann Arbor, Michigan and the surrounding area. All participants provided an oral sample at baseline, and 130 females provided a cervicogenital sample. Samples were tested for 18 HPV genotypes using polymerase chain reaction (PCR) MassArray. Participants filled out sociodemographic and behavioral questionnaires. Prevalence ratios for HPV oral or cervicogenital prevalence by predictor variables were estimated in univariable log-binomial models. Analysis was conducted 2018–20. In the full cohort, baseline oral HPV prevalence was 10.0% for any detected genotype (among the 338 valid oral tests at baseline) and 6.5% for high-risk types, and cervicogenital prevalence was 20.0% and 10.8%, respectively (among the 130 first valid cervicogenital tests). Oral HPV prevalence did not vary by sex, with 10.5% of women and 9.0% of men having an infection. We found a high prevalence of oral and cervicogenital HPV infection in college-age participants reporting no lifetime sexual partners. Reporting a single recent partner was associated with a lower oral HPV prevalence (PR 0.39, 95% CI: 0.16, 0.96) than reporting no recent (but at least one ever) partner. No similar protective effect was seen for cervicogenital HPV. Both oral and cervicogenital prevalence increased with the number of recent partners for most sexual behaviors. We observed an ecological fallacy masking the direction of impact of vaccination on HPV prevalence in the full cohort compared to the college-aged and the age 23+ populations considered separately. Substance use was not significantly associated with oral or cervicogenital HPV infection. Many studies report substantially higher oral HPV infection prevalence in men than in women. That difference may not be uniform across populations in the US.
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Affiliation(s)
- Andrew F. Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail:
| | - Lora P. Campredon
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Heather M. Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Brittany M. Marinelli
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Christine M. Goudsmit
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Trey B. Thomas
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Rachel L. Delinger
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Yan Kwan Lau
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Emily C. Andrus
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Monica L. Yost
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jodi K. McCloskey
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Taylor S. Sullivan
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Alex S. Mortensen
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Suiyuan Huang
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Keith Murphy
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Bonnie Cheng
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Kayla Stanek
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Thankam Nair
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Thomas E. Carey
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Marisa C. Eisenberg
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
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Brouwer AF, Campredon LP, Walline HM, Marinelli BM, Goudsmit CM, Thomas TB, Delinger RL, Lau YK, Andrus EC, Nair T, Carey TE, Eisenberg MC, Meza R. Incidence and clearance of oral and cervicogenital HPV infection: longitudinal analysis of the MHOC cohort study. BMJ Open 2022; 12:e056502. [PMID: 34980629 PMCID: PMC8724815 DOI: 10.1136/bmjopen-2021-056502] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The Michigan HPV and Oropharyngeal Cancer study aimed to evaluate patterns of oral and cervicogenital human papillomavirus (HPV) infection prevalence, incidence, and clearance as well as their relationship to sexual behaviours. DESIGN Cohort SETTING: General public in and around Ann Arbor, Michigan. PARTICIPANTS 394 college-age and older-adult participants of both sexes provided oral samples, and 325 completed at least 2 visits. 130 who provided a cervicogenital samples, and 127 completed at least 2 visits. OUTCOMES Incidence and clearance rates as well as HRs for oral and cervicogenital HPV. RESULTS Oral HPV infections were transient, with only 16% of genotypes persisting to the next visit. The mean time to clearance of a genotype was 46 days (95% CI 37 to 58). In contrast, cervicogenital infections were more persistent, with 56% of genotypes persisting to the next visit. The mean time to clearance of a genotype was 87 days (95% CI 74 to 102). HPV vaccination was associated with reduced incidence of cervicogenital HPV infection (HR 0.63; 95% CI 0.47 to 0.83) but not oral HPV infection. Incidence of oral HPV infection was associated with 2+ recent deep kissing partners (HR 2.00; 95% CI 1.13 to 3.56). Incidence of both oral (HR: 1.70; 95% CI 1.08 to 2.68) and cervicogenital (HR 2.46; 95% CI 1.69 to 3.59) was associated with 2+ recent sexual partners. CONCLUSIONS Detection of oral HPV was highly transient, but incidence was associated with recent deep kissing and sexual partners. Detection of cervicogenital HPV was more persistent, and incidence was positively associated with recent sexual partners and negatively associated with HPV vaccination.
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Affiliation(s)
- Andrew F Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lora P Campredon
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Heather M Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Trey B Thomas
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rachel L Delinger
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yan Kwan Lau
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily C Andrus
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Thankam Nair
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas E Carey
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Marisa C Eisenberg
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
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Lorenzatti Hiles G, Chang KP, Bellile EL, Wang CI, Yen WC, Goudsmit CM, Briggs HL, Thomas TB, Peters L, Afsari MA, Pinatti LM, Morris AC, Jawad N, Carey TE, Walline HM. Understanding the impact of high-risk human papillomavirus on oropharyngeal squamous cell carcinomas in Taiwan: A retrospective cohort study. PLoS One 2021; 16:e0250530. [PMID: 33891627 PMCID: PMC8064583 DOI: 10.1371/journal.pone.0250530] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/08/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Human papillomavirus (HPV)-driven oropharyngeal squamous cell carcinoma (OPSCC) is increasing globally. In Taiwan, HPV-positive OPSCC is obscured by tobacco, alcohol, and betel quid use. We investigated the role of high-risk HPV (hrHPV) in a large retrospective Taiwan OPSCC cohort. METHODS AND RESULTS The cohort of 541 OPSCCs treated at Chang Gung Memorial Hospital from 1998-2016 consisted of 507 men (94%) and 34 women (6%). Most used tobacco (81%), alcohol (51%), and betel quid (65%). Formalin-fixed, paraffin-embedded tissue was used for p16 staining (a surrogate marker for HPV) and testing for HPV DNA presence and type by Multiplex HPV PCR-MassArray. HPV DNA and/or p16 staining (HPV-positive) was found in 28.4% (150/528) tumors. p16 and HPV DNA were strongly correlated (F < 0.0001). HPV16 was present in 82.8%, and HPV58 in 7.5% of HPV-positive tumors. HPV was associated with higher age (55.5 vs. 52.7 years, p = 0.004), lower T-stage (p = 0.008) better overall survival (OS) (hazard ratio [HR] 0.58 [95% CI 0.42-0.81], p = 0.001), and disease-free survival (DFS) (HR 0.54 [95% CI 0.40-0.73], p < 0.0001). Alcohol was strongly associated with recurrence and death (OS: HR 2.06 [95% CI 1.54-2.74], p < 0.0001; DFS: HR 1.72 [95% CI 1.33-2.24], p < 0.0001). OS and DFS in HPV-positive cases decreased for alcohol users (p < 0.0001). Obscured by the strong alcohol effect, predictive associations were not found for tobacco or betel quid. CONCLUSIONS As with HPV-positive OPSCC globally, HPV is an increasingly important etiological factor in Taiwanese OPSCC. HPV-positive OPSCC has considerable survival benefit, but this is reduced by alcohol, tobacco, and betel quid use. hrHPV is a cancer risk factor in males and females. Vaccinating both sexes with a multivalent vaccine including HPV58, combined with alcohol and tobacco cessation policies will be effective cancer-prevention public health strategies in Taiwan.
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Affiliation(s)
- Guadalupe Lorenzatti Hiles
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Kai-Ping Chang
- Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital (Linkou Medical Center), Taoyuan, Taiwan, Republic of China
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Emily L. Bellile
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Chun-I Wang
- Radiation Biology Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China
| | - Wei-Chen Yen
- Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital (Linkou Medical Center), Taoyuan, Taiwan, Republic of China
| | - Christine M. Goudsmit
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Hannah L. Briggs
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Trey B. Thomas
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Lila Peters
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Macy A. Afsari
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Lisa M. Pinatti
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
- Cancer Biology Program, Rackham Graduate School, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Anna C. Morris
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Nadine Jawad
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Thomas E. Carey
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Heather M. Walline
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
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8
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Pinatti LM, Sinha HN, Brummel CV, Goudsmit CM, Geddes TJ, Wilson GD, Akervall JA, Brenner CJ, Walline HM, Carey TE. Association of human papillomavirus integration with better patient outcomes in oropharyngeal squamous cell carcinoma. Head Neck 2020; 43:544-557. [PMID: 33073473 DOI: 10.1002/hed.26501] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/04/2020] [Accepted: 09/24/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The molecular drivers of human papillomavirus-related head and neck squamous cell carcinoma (HPV + HNSCC) are not entirely understood. This study evaluated the relationship between HPV integration, expression of E6/E7, and patient outcomes in p16+ HNSCCs. METHODS HPV type was determined by HPV PCR-MassArray, and integration was called using detection of integrated papillomavirus sequences polymerase chain reaction (PCR). We investigated whether fusion transcripts were produced by reverse transcriptase polymerase chain reaction (RT-PCR). E6/E7 expression was assessed by quantitative RT-PCR. We assessed if there was a relationship between integration and E6/E7 expression, clinical variables, or patient outcomes. RESULTS Most samples demonstrated HPV integration, which sometimes resulted in a fusion transcript. HPV integration was positively correlated with age at diagnosis and E6/E7 expression. There was a significant difference in survival between patients with vs without integration. CONCLUSIONS Contrary to previous reports, HPV integration was associated with improved patient survival. Therefore, HPV integration may act as a molecular marker of good prognosis.
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Affiliation(s)
- Lisa M Pinatti
- Cancer Biology Program, Program in the Biomedical Sciences, Rackham Graduate School, University of Michigan, Ann Arbor, Michigan, USA.,Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Hana N Sinha
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Collin V Brummel
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Christine M Goudsmit
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - George D Wilson
- Beaumont BioBank, Beaumont Hospital, Royal Oak, Michigan, USA.,Department of Radiation Oncology, Beaumont Hospital, Royal Oak, Michigan, USA
| | - Jan A Akervall
- Beaumont BioBank, Beaumont Hospital, Royal Oak, Michigan, USA.,Department of Otolaryngology, Saint Joseph Mercy Hospital, Ypsilanti, Michigan, USA
| | - Chad J Brenner
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Heather M Walline
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas E Carey
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Hiles GL, Wang CI, Pinatti LM, Goudsmit CM, Peters L, Briggs HL, Thomas TB, Charara M, Khatib RA, Afsari MA, Morris AC, Jawad N, Som D, Chang KP, Carey TE, Walline HM. Abstract B07: High-risk human papillomavirus association with oropharyngeal squamous cell carcinoma in Taiwan. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.aacrahns19-b07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Taiwan has a high rate of oropharyngeal squamous cell carcinoma (OPSCC). The etiologic factors are primarily tobacco and alcohol abuse. High-risk human papillomaviruses (hrHPV) have been reported in oral cancers in Taiwan, but their role in oropharyngeal cancer has not been studied. We investigated the possible role of hrHPV in OPSCC Taiwanese patients.
Materials and Methods: We identified 546 OPSCC tumors from patients undergoing standard care and informed consent, between 1998 and 2016, at the Chang Gung Memorial Hospital (CGMH) in Taiwan. Formalin-fixed, paraffin-embedded (FFPE) tissue sections from 504 patients were screened by p16 immunostaining, a surrogate marker for active HPV (Ventana antibody, Cat. No. 725-4713, prediluted), and scored for intensity and proportion of positive tumor cells according to the 2018 College of American Pathologists recommendations. Genomic DNA was extracted from FFPE sections (AllPrep Kit, Qiagen) and HPV was detected and genotyped by Multiplex PCR-Mass Array (PCR-MA) analysis designed to detect 15 high-risk, 1 intermediate-risk, and 2 low-risk HPV types.
Results: Of the 504 OPSCC tumors tested for p16, 104 (20.6%) were positive, 380 (75.4%) negative, and 20 (4.0%) could not be scored. Spearman nonparametric correlation analysis demonstrated a linear increase in p16 positivity with time from 1998 to 2015 in this Taiwanese population (r= 0.6320, p= 0.003; R2= 0.4901, p= 0.0012). To date, HPV genotyping in 179 Taiwan tumors showed that 38 (21.2%) were hrHPV positive, 120 (67.0%) negative, and 21 (11.7%) had insufficient DNA. Of the 38 HPV-positive tumors, HPV16 alone was found in 31 (81.6%), HPV39 and HPV59 were each found once in separate tumors, and several tumors had two HPV types present: HPV16 and HPV18 were present together in 2 tumors, and each of the following pairs were found in one tumor each: HPV16 with HPV35, HPV16 with HPV59, and HPV16 with HPV6. Of the tumors tested by both p16 and PCR-MA, there was 97% concordance between the results (130/134).
Conclusion: Our preliminary findings indicate that the proportion of hrHPV positive OPSCC tumors in this Taiwanese population is increasing over the period from 1998 to 2015 in Taiwan. The concordance of p16 and HPV DNA is very high (p<0.0001), demonstrating that the hrHPV in the tumors is transcriptionally active and likely is an etiologic factor in the majority of OPSCC patients treated at CGMH in the past 18 years. This is consistent with the increasing role of hrHPV in OPSCC in Western countries and may reflect changing socioeconomic trends in Taiwan.
Citation Format: Guadalupe Lorenzatti Hiles, Chun-I Wang, Lisa M. Pinatti, Christine M. Goudsmit, Lila Peters, Hannah L. Briggs, Trey B. Thomas, Mohammed Charara, Reem A. Khatib, Macy A. Afsari, Anna C. Morris, Nadine Jawad, Devraj Som, Kai-Ping Chang, Thomas E. Carey, Heather M. Walline. High-risk human papillomavirus association with oropharyngeal squamous cell carcinoma in Taiwan [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B07.
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Affiliation(s)
| | - Chun-I Wang
- 2Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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Udager AM, McHugh JB, Goudsmit CM, Weigelin HC, Lim MS, Elenitoba-Johnson KSJ, Betz BL, Carey TE, Brown NA. Human papillomavirus (HPV) and somatic EGFR mutations are essential, mutually exclusive oncogenic mechanisms for inverted sinonasal papillomas and associated sinonasal squamous cell carcinomas. Ann Oncol 2019; 29:466-471. [PMID: 29145573 DOI: 10.1093/annonc/mdx736] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Inverted sinonasal (Schneiderian) papilloma (ISP) is a locally aggressive neoplasm often associated with sinonasal squamous cell carcinoma (SNSCC). While the etiology of ISP is not well understood, human papillomavirus (HPV) has been detected in a subset of cases. Our group recently identified activating somatic EGFR mutations in the majority of ISP and ISP-associated SNSCC. However, the relationship between EGFR mutations and HPV infection has not been explored. Patients and methods We evaluated 58 ISP and 22 ISP-associated SNSCC (including 13 patients with matched ISP/SNSCC samples), as well as 14 SNSCC without clinical or pathologic evidence of an associated ISP. Formalin-fixed, paraffin-embedded samples were evaluated for EGFR mutations using Sanger sequencing and for HPV infection using GP5+/GP6+ PCR. HPV subtyping based on the L1 sequence was done for HPV positive cases including temporally distinct tumors for four patients. Clinicopathologic data including progression free survival was also analyzed. Results All ISP and ISP-associated SNSCC demonstrated either an EGFR mutation or HPV infection. HPV and EGFR mutation were mutually exclusive in all cases of ISP-associated SNSCC and all but one ISP; this case was only weakly HPV positive, and analysis of a prior temporally distinct ISP specimen from this patient failed to show HPV infection, suggesting transient infection/incidental colonization. HPV subtypes in ISP and ISP-associated SNSCC were predominantly low-risk, in contrast with SNSCC without ISP association, which showed frequent high-risk HPV. All paired ISP and associated SNSCC samples demonstrated concordant HPV status and EGFR genotypes. ISP progression to SNSCC was significantly associated with the presence of HPV infection and the absence of an EGFR mutation (log-rank = 9.620, P = 0.002). Conclusions Collectively our data show that EGFR mutations and HPV infection represent essential, alternative oncogenic mechanisms in ISP and ISP-associated SNSCC.
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Affiliation(s)
- A M Udager
- Department of Pathology, University of Michigan Medical School, Ann Arbor, USA
| | - J B McHugh
- Department of Pathology, University of Michigan Medical School, Ann Arbor, USA
| | - C M Goudsmit
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, USA
| | - H C Weigelin
- Department of Pathology, University of Michigan Medical School, Ann Arbor, USA
| | - M S Lim
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - K S J Elenitoba-Johnson
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - B L Betz
- Department of Pathology, University of Michigan Medical School, Ann Arbor, USA
| | - T E Carey
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, USA
| | - N A Brown
- Department of Pathology, University of Michigan Medical School, Ann Arbor, USA.
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11
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Eisenberg MC, Campredon LP, Brouwer AF, Walline HM, Marinelli BM, Lau YK, Thomas TB, Delinger RL, Sullivan TS, Yost ML, Goudsmit CM, Carey TE, Meza R. Dynamics and Determinants of HPV Infection: The Michigan HPV and Oropharyngeal Cancer (M-HOC) Study. BMJ Open 2018; 8:e021618. [PMID: 30282679 PMCID: PMC6169774 DOI: 10.1136/bmjopen-2018-021618] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) is the primary cause of cervical and other anogenital cancers and is also associated with head and neck cancers. Incidence of HPV-related oropharyngeal squamous cell cancers (OPSCCs) is increasing, and HPV-related OPSCCs have surpassed cervical cancer as the most common HPV-related cancer in the USA. Given the multisite nature of HPV, there is strong interest in collecting data from both genital and oral sites, as well as associated data on social and sexual behaviours. The overarching goal of this study is to evaluate patterns of oral HPV infection incidence, clearance and persistence and their relationship to sexual behaviour history. METHODS AND ANALYSIS Participants are recruited from two populations: college students at a large public university and general population from the surrounding area. At the first study visit, participants complete a detailed sexual history, health and behaviour questionnaire. Follow-up visits occur every 3-4 months over 3 years, when participants complete an abbreviated questionnaire. All participants provide a saliva sample at each visit, and eligible participants may provide a cervicovaginal self-swab. Genetic material isolated from specimens is tested for 15 high-risk and 3 low-risk HPV types. Statistical analyses will examine outcome variables including HPV prevalence, incidence, persistence and clearance. Logistic regression models will be used to estimate odds ratios and 95% confidence intervals for associations between the outcomes of interest and demographic/behavioural variables collected in the questionnaires. The longitudinal HPV infection data and detailed sexual history data collected in the questionnaires will allow us to develop individual-based network models of HPV transmission and will be used to parameterise multiscale models of HPV-related OPSC carcinogenesis. ETHICS AND DISSEMINATION This study has been approved by the University of Michigan Institutional Review Board. All participants are consented in person by trained study staff. Study results will be disseminated through peer-reviewed publications.
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Affiliation(s)
- Marisa C Eisenberg
- Department of Epidemiology, University of Michigan, Ann Arbor, Ann Arbor, Michigan, USA
| | - Lora P Campredon
- Department of Epidemiology, University of Michigan, Ann Arbor, Ann Arbor, Michigan, USA
| | - Andrew F Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, Ann Arbor, Michigan, USA
| | - Heather M Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, Ann Arbor, Michigan, USA
| | - Brittany M Marinelli
- Department of Otolaryngology, University of Michigan, Ann Arbor, Ann Arbor, Michigan, USA
| | - Yan Kwan Lau
- Department of Epidemiology, University of Michigan, Ann Arbor, Ann Arbor, Michigan, USA
| | - Trey B Thomas
- Department of Otolaryngology, University of Michigan, Ann Arbor, Ann Arbor, Michigan, USA
| | - Rachel L Delinger
- Department of Epidemiology, University of Michigan, Ann Arbor, Ann Arbor, Michigan, USA
| | - Taylor S Sullivan
- Department of Epidemiology, University of Michigan, Ann Arbor, Ann Arbor, Michigan, USA
| | - Monica L Yost
- Department of Epidemiology, University of Michigan, Ann Arbor, Ann Arbor, Michigan, USA
| | - Christine M Goudsmit
- Department of Otolaryngology, University of Michigan, Ann Arbor, Ann Arbor, Michigan, USA
| | - Thomas E Carey
- Department of Otolaryngology, University of Michigan, Ann Arbor, Ann Arbor, Michigan, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Ann Arbor, Michigan, USA
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12
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VanKoevering KK, Marchiano E, Walline HM, Carey TE, McHugh JB, Brenner JC, Goudsmit CM, Belille E, Spector ME, Shuman AG. An Algorithm to Evaluate Suspected Lung Metastases in Patients with HPV-Associated Oropharyngeal Cancer. Otolaryngol Head Neck Surg 2017; 158:118-121. [PMID: 28949800 DOI: 10.1177/0194599817733677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Distinguishing between distantly metastatic and metachronous lung primary carcinoma is challenging for patients with a history of head and neck cancer. There are implications for registry data, prognosis and related counseling, and management options, including eligibility for precision oncology trials. Patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma who were treated under a uniform clinical protocol and achieved a complete response were identified in a single-institution prospective head and neck cancer epidemiology database (n = 205). Fifteen patients presented with pulmonary nodule(s) after completion of therapy. We describe our algorithm for the evaluation of these patients, including histopathology, p16 immunohistochemistry, and HPV in situ hybridization.
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Affiliation(s)
- Kyle K VanKoevering
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Emily Marchiano
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Heather M Walline
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Thomas E Carey
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Jonathan B McHugh
- 2 Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - J Chad Brenner
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Christine M Goudsmit
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Emily Belille
- 3 Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew E Spector
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Andrew G Shuman
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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13
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Walline HM, Goudsmit CM, McHugh JB, Tang AL, Owen JH, Teh BT, McKean E, Glover TW, Graham MP, Prince ME, Chepeha DB, Chinn SB, Ferris RL, Gollin SM, Hoffmann TK, Bier H, Brakenhoff R, Bradford CR, Carey TE. Integration of high-risk human papillomavirus into cellular cancer-related genes in head and neck cancer cell lines. Head Neck 2017; 39:840-852. [PMID: 28236344 DOI: 10.1002/hed.24729] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 11/16/2016] [Accepted: 12/29/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-positive oropharyngeal cancer is generally associated with excellent response to therapy, but some HPV-positive tumors progress despite aggressive therapy. The purpose of this study was to evaluate viral oncogene expression and viral integration sites in HPV16- and HPV18-positive squamous cell carcinoma lines. METHODS E6/E7 alternate transcripts were assessed by reverse transcriptase-polymerase chain reaction (RT-PCR). Detection of integrated papillomavirus sequences (DIPS-PCR) and sequencing identified viral insertion sites and affected host genes. Cellular gene expression was assessed across viral integration sites. RESULTS All HPV-positive cell lines expressed alternate HPVE6/E7 splicing indicative of active viral oncogenesis. HPV integration occurred within cancer-related genes TP63, DCC, JAK1, TERT, ATR, ETV6, PGR, PTPRN2, and TMEM237 in 8 head and neck squamous cell carcinoma (HNSCC) lines but UM-SCC-105 and UM-GCC-1 had only intergenic integration. CONCLUSION HPV integration into cancer-related genes occurred in 7 of 9 HPV-positive cell lines and of these 6 were from tumors that progressed. HPV integration into cancer-related genes may be a secondary carcinogenic driver in HPV-driven tumors. © 2017 Wiley Periodicals, Inc. Head Neck 39: 840-852, 2017.
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Affiliation(s)
- Heather M Walline
- Cancer Biology Program, Program in the Biomedical Sciences, Rackham Graduate School, University of Michigan, Ann Arbor, Michigan.,Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Christine M Goudsmit
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Alice L Tang
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.,Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio
| | - John H Owen
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Bin T Teh
- National Cancer Centre - Cancer Science Institute of Singapore, Duke-NUS Graduate Medical School, Singapore
| | - Erin McKean
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Thomas W Glover
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan
| | - Martin P Graham
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Mark E Prince
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Douglas B Chepeha
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Steven B Chinn
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Susanne M Gollin
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Thomas K Hoffmann
- Department of Otolaryngology, Heinrich Heine University, Dusseldorf, Germany.,Department of Otolaryngology, University of Ulm, Ulm, Germany
| | - Henning Bier
- Department of Otolaryngology, Heinrich Heine University, Dusseldorf, Germany.,Department of Otolaryngology, Technical University Medical Center, Munich, Germany
| | - Ruud Brakenhoff
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Carol R Bradford
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Thomas E Carey
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
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14
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Walline HM, Carey TE, Goudsmit CM, Bellile EL, D'Souza G, Peterson LA, McHugh JB, Pai SI, Lee JJ, Shin DM, Ferris RL. High-Risk HPV, Biomarkers, and Outcome in Matched Cohorts of Head and Neck Cancer Patients Positive and Negative for HIV. Mol Cancer Res 2016; 15:179-188. [PMID: 27899422 DOI: 10.1158/1541-7786.mcr-16-0255] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/28/2016] [Accepted: 11/07/2016] [Indexed: 01/27/2023]
Abstract
In this study, high-risk HPV (hrHPV) incidence, prognostic biomarkers, and outcome were assessed in HIV-positive (case) and HIV-negative (control) patients with head and neck squamous cell cancer (HNSCC). HIV-positive cases were matched to controls by tumor site, sex, and age at cancer diagnosis. A tissue microarray (TMA) was constructed and DNA isolated from tumor tissue. MultiPlex-PCR MassArray, L1-PCR, and in situ hybridization were used to assess hrHPV. TMA sections were stained for p16ink4a, TP53, RB, CCND1, EGFR, and scored for intensity and proportion of positive tumor cells. The HNSCC cohort included 41 HIV-positive cases and 41 HIV-negative controls. Tumors from 11 of 40 (28%) cases, and 10 of 41 (24%) controls contained hrHPV. p16 expression, indicative of E7 oncogene activity, was present in 10 of 11 HPV-positive cases and 7 of 10 HPV-positive controls. Low p16 and high TP53 expression in some HPV-positive tumors suggested HPV-independent tumorigenesis. Survival did not differ in cases and controls. RB expression was significantly associated with poor survival (P = 0.01). High TP53 expression exhibited a trend for poorer survival (P = 0.12), but among cases, association with poor survival reached statistical significance (P = 0.04). The proportion of HPV-positive tumors was similar, but the heterogeneity of HPV types was higher in the HIV-positive cases than in HIV-negative controls. High RB expression predicted poor survival, and high TP53 expression was associated with poorer survival in the HIV-positive cases but not HIV-negative controls. IMPLICATIONS HIV infection did not increase risk of death from HNSCC, and HPV-positive tumors continued to be associated with a significantly improved survival, independent of HIV status. Mol Cancer Res; 15(2); 179-88. ©2016 AACR.
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Affiliation(s)
- Heather M Walline
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.,Cancer Biology Training Program, University of Michigan, Ann Arbor, Michigan
| | - Thomas E Carey
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Christine M Goudsmit
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Emily L Bellile
- Biostatistics Core, Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Gypsyamber D'Souza
- Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Lisa A Peterson
- Head and Neck SPORE, University of Michigan Cancer Center, Ann Arbor, Michigan
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Sara I Pai
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - J Jack Lee
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas
| | - Dong M Shin
- Department of Medicine, Medical Oncology Winship Cancer Center, Emory University, Atlanta, Georgia
| | - Robert L Ferris
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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