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Syrjänen K, Shabalova I, Naud P, Kozachenko V, Derchain S, Zakharchenko S, Roteli-Martins C, Nerovjna R, Longatto-Filho A, Kljukina L, Tatti S, Branovskaja M, Hammes LS, Branca M, Grunjberga V, Eržen M, Juschenko A, Costa S, Sarian L, Podistov J, Syrjäen S, Syrjänen K, Syrjänen S, Shabalova I, Petrovichev N, Kozachenko V, Zakharova T, Pajanidi J, Podistov J, Chemeris G, Sozaeva L, Lipova E, Tsidaeva I, Ivanchenko O, Pshepurko A, Zakharenko S, Nerovjna R, Kljukina L, Erokhina O, Branovskaja M, Nikitina M, Grunjberga V, Grunjberg A, Juschenko A, Santopietro R, Cintorino M, Tosi P, Syrjänen K, Naud P, Derchain S, Roteli-Martins C, Longatto-Filho A, Tatti S, Branca M, Eržen M, Hammes LS, Matos J, Gontijo R, Sarian L, Braganća J, Arlindo FC, Maeda MYS, Lörincz A, Dores GB, Costa S, Syrjänen S. Risk estimates for persistent high-risk human papillomavirus infections as surrogate endpoints of progressive cervical disease critically depend on reference category: analysis of the combined prospective cohort of the New Independent States of the Former Soviet Union and Latin American Screening Studies. Int J STD AIDS 2011; 22:315-23. [DOI: 10.1258/ijsa.2009.009365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Summary To make feasible future clinical trials with new-generation human papillomavirus (HPV) vaccines, novel virological surrogate endpoints of progressive disease have been proposed, including high-risk HPV (HR-HPV) persistence for six months (6M+) or 12 months (12M+). The risk estimates (relative risks [RRs]) of these ‘virological endpoints’ are influenced by several variables, not yet validated adequately. We compared the impact of three referent groups: (i) HPV-negative, (ii) HPV-transient, (iii) HPV-mixed outcome on the risk estimates for 6M+ or 12M+ HR-HPV persistence as predictors of progressive disease. Generalized estimating equation models were used to estimate the strength of 6M+ and 12M+ HR-HPV persistence with disease progression to squamous intraepithelial lesions (SILs), cervical intraepithelial neoplasia (CIN) grade 1 +, CIN2+, CIN/SIL endpoints, comparing three optional reference categories (i)-(iii) in a prospective sub-cohort of 1865 women from the combined New Independent States of the Former Soviet Union (NIS) and Latin American Screening (LAMS) studies cohort ( n = 15,301). The RRs of these viral endpoints as predictors of progressive disease are affected by the length of viral persistence (6M+ or 12M+) and the surrogate endpoint (SIL, CIN1, CIN2, CIN/SIL). Most dramatic is the effect of the referent group used in risk estimates, with the HPV-negative referent group giving the highest and most consistent RRs for both 6M+ and 12M+ viral persistence, irrespective of which surrogate is used. In addition to deciding on whether to use 6M+ or 12M+ persistence criteria, and cytological, histological or combined surrogate endpoints, one should adopt the HPV-negative referent group as the gold standard in all future studies using viral persistence as the surrogate endpoint of progressive disease.
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Affiliation(s)
- K Syrjänen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - I Shabalova
- Russian Academy of Post-Graduate Medical Education. Moscow, Russia
| | - P Naud
- Hospital de Clinicas de Porto Alegre, and Department of Gynecology and Obstetrics, Federal University of Rio Grande do Sul. Porto Alegre
| | - V Kozachenko
- Russian Academy of Post-Graduate Medical Education. Moscow, Russia
| | - S Derchain
- Universidade Estadual de Campinas, Campinas, Brazil
| | - S Zakharchenko
- Novgorod Municipal Dermato-venereological Dispensary, Department of Gynaecology, Novgorod, Russia
| | | | - R Nerovjna
- Novgorod Female Consultative Outpatient Hospital. Department of Gynaecology, Novgorod, Russia
| | - A Longatto-Filho
- lnstituto Adolfo Lutz, Sao Paulo, Brazil and Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - L Kljukina
- Research Institute of Oncology and Medical Radiology, Republican Centre of Clinical Cytology, Minsk, Belarus
| | - S Tatti
- First Chair Gynecology Hospital de Clinicas, Buenos Aires, Argentina
| | - M Branovskaja
- Minsk State Medical Institute. Department of Gynaecology and Obstetrics, Minsk, Belarus
| | - L S Hammes
- Hospital de Clinicas de Porto Alegre, and Department of Gynecology and Obstetrics, Federal University of Rio Grande do Sul. Porto Alegre
| | - M Branca
- Unit of Cytopathology, National Centre of Epidemiology, Surveillance and Promotion of Health, National Institute of Health (ISS), Rome, Italy
| | - V Grunjberga
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - M Eržen
- SIZE Diagnostic Center, Ljubljana, Slovenia
| | - A Juschenko
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - S Costa
- Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - L Sarian
- Universidade Estadual de Campinas, Campinas, Brazil
| | - J Podistov
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - S Syrjäen
- Department of Oral Pathology, Institute of Dentistry, University of Turku, Turku, Finland
| | - K Syrjänen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - S Syrjänen
- Department of Oral Pathology, Institute of Dentistry, and MediCity Research Laboratory, University of Turku, Finland
| | - I Shabalova
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
- Russian Academy of Post-Graduate Medical Education, Moscow, Russia
| | - N Petrovichev
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - V Kozachenko
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - T Zakharova
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - J Pajanidi
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - J Podistov
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - G Chemeris
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - L Sozaeva
- Russian Academy of Post-Graduate Medical Education, Moscow, Russia
| | - E Lipova
- Russian Academy of Post-Graduate Medical Education, Moscow, Russia
| | - I Tsidaeva
- Russian Academy of Post-Graduate Medical Education, Moscow, Russia
| | - O Ivanchenko
- Novgorod Clinical Regional Hospital, Centralised Cytology Laboratory, Novgorod, Russia
| | - A Pshepurko
- Novgorod Clinical Regional Hospital, Centralised Cytology Laboratory, Novgorod, Russia
| | - S Zakharenko
- Novgorod Municipal Dermato-venereological Dispensary, Department of Gynaecology, Novgorod, Russia
| | - R Nerovjna
- Novgorod Female Consultative Outpatient Hospital, Department of Gynaecology, Novgorod, Russia
| | - L Kljukina
- Research Institute of Oncology and Medical Radiology, Republican Centre of Clinical Cytology, Minsk, Belarus
| | - O Erokhina
- Research Institute of Oncology and Medical Radiology, Republican Centre of Clinical Cytology, Minsk, Belarus
| | - M Branovskaja
- Minsk State Medical Institute, Department of Gynaecology and Obstetrics, Minsk, Belarus
| | - M Nikitina
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - V Grunjberga
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - A Grunjberg
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - A Juschenko
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - R Santopietro
- Department of Human Pathology and Oncology, University of Siena, Italy
| | - M Cintorino
- Department of Human Pathology and Oncology, University of Siena, Italy
| | - P Tosi
- Department of Human Pathology and Oncology, University of Siena, Italy
| | - K Syrjänen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - P Naud
- Hospital de Clinicas de Porto Alegre, Brazil
| | - S Derchain
- Universidade Estadual de Campinas, Campinas, Brazil
| | | | - A Longatto-Filho
- Instituto Adolfo Lutz, Sao Paulo, Brazil and (ALF) Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - S Tatti
- First Chair Gynecology Hospital de Clinicas, Buenos Aires, Argentina
| | - M Branca
- Unit of Cytopathology, National Centre of Epidemiology, Surveillance and Promotion of Health, National Institute of Health (ISS), Rome, Italy
| | - M Eržen
- SIZE Diagnostic Center, Ljubljana, Slovenia
| | - LS Hammes
- Hospital de Clinicas de Porto Alegre, Brazil
| | - J Matos
- Hospital de Clinicas de Porto Alegre, Brazil
| | - R Gontijo
- Universidade Estadual de Campinas, Campinas, Brazil
| | - L Sarian
- Universidade Estadual de Campinas, Campinas, Brazil
| | - J Braganća
- Universidade Estadual de Campinas, Campinas, Brazil
| | - FC Arlindo
- Hospital Leonor M de Barros, Sao Paulo, Brazil
| | - MYS Maeda
- Instituto Adolfo Lutz, Sao Paulo, Brazil and (ALF) Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | | | - GB Dores
- Di gene Brazil, Sao Paulo, Brazil
| | - S Costa
- Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - S Syrjänen
- Department of Oral Pathology, Institute of Dentistry, University of Turku, Finland
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Syrjänen K, Kulmala SM, Shabalova I, Petrovichev N, Kozachenko V, Zakharova T, Pajanidi J, Podistov J, Chemeris G, Sozaeva L, Lipova E, Tsidaeva I, Ivanchenko O, Pshepurko A, Zakharenko S, Nerovjna R, Kljukina L, Erokhina O, Branovskaja M, Nikitina M, Grunjberga V, Grunjberg A, Juschenko A, Santopietro R, Cintorino M, Tosi P, Syrjänen S. Epidemiological, clinical and viral determinants of the increased prevalence of high-risk human papillomavirus (HPV) infections in elderly women. EUR J GYNAECOL ONCOL 2008; 29:114-122. [PMID: 18459542] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Population-based studies have reported a second peak of human papillomavirus (HPV) prevalence among women > 55 years, but reasons for this U-shaped HPV prevalence curve are poorly understood. OBJECTIVES To analyse determinants of high-risk HPV (HR-HPV) infections among postmenopausal women. STUDY DESIGN AND METHODS A cohort of 3,187 women was stratified into three age categories: i) youngest age group < 25 years (n = 1.103); ii) women between 26-55 years (n = 2.004), and iii) women > 55 years (n = 80), analysed for epidemiological, clinical and virological determinants of their HR-HPV infections. Real-time PCR was used for HPV genotyping, analysis of viral loads for HPV16, 18/45, 31, 33/52/58, 35 and 39, and load of integrated HPV16. RESULTS Age-standardised prevalence of HR-HPV infections showed a second peak among women > 55 years, with a perfect U-shaped curve (R2 = 0.966). The factors explaining this increased HR-HPV prevalence among older women include: i) cohort effect, ii) higher viral loads for HR-HPV types with cubic model curve (R2 = 0.714) for HPV 16, iii) distinct shift (p = 0.0001) from multiple-type infections to single HR-HPV types, iv) transition from episomal to integrated HPV16 (p = 0.009), v) higher load of integrated HPV16 (p = 0.009), and, vi) higher proportion of incident infections, higher rate of viral persistence, and lower rate of HR-HPV clearance. CONCLUSIONS These data suggest that in women who fail to eradicate their HR-HPV infection until menopause, selection of integrated viral clone has taken place, driving the process towards progressing disease. Consequent to this, most of the HR-HPV infections in women > 55 years were associated with high-grade CIN or invasive carcinoma.
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Affiliation(s)
- K Syrjänen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland.
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Syrjänen S, Shabalova IP, Petrovichev N, Kozachenko VP, Zakharova T, Pajanidi A, Podistov JI, Chemeris G, Sozaeva LG, Lipova EV, Tsidaeva I, Ivanchenko OG, Pshepurko AA, Zakharenko S, Nerovjna R, Kljukina LB, Erokhina OA, Branovskaja MF, Nikitina M, Grunberga V, Grunberg A, Juschenko A, Tosi P, Cintorino M, Santopietro R, Syrjänen KJ. Clearance of high-risk human papillomavirus (HPV) DNA and PAP smear abnormalities in a cohort of women subjected to HPV screening in the New Independent States of the former Soviet Union (the NIS cohort study). Eur J Obstet Gynecol Reprod Biol 2005; 119:219-27. [PMID: 15808384 DOI: 10.1016/j.ejogrb.2004.07.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2003] [Revised: 06/10/2004] [Accepted: 07/31/2004] [Indexed: 11/18/2022]
Abstract
BACKGROUND We analysed the temporal relationships of the clearance of human papillomavirus (HPV) DNA and cytological abnormalities in women participating in a screening study in three NIS countries. METHODS The 274 patients included in this analysis were prospectively followed-up for 21.6 months (range: 0.5-42.9). All 274 women had abnormal PAP test (ASC-US or higher) and high-risk HPV-positive test (HCII) at baseline. Two groups were compared: 132 women who cleared both tests (Group 1), and 142 women who cleared either HPV or abnormal PAP test (Group 2). The first clearance during the follow-up, and the last visit clearance were modeled using life-table techniques, and the predictive factors were analysed using univariate (Kaplan-Meier) and multivariate (Cox) survival analysis. RESULTS There was no difference in the mean clearance time for the abnormal PAP test (14.4 months; 0.7-40.5 and 12.6 months; 0.5-35.0) and high-risk HPV DNA (12.67 months; 0.6-33.5 and 10.8 months; 0.7-33.4) in Group 1 and Group 2 (Mann-Whitney: P = 0.107 and P = 0.082, respectively). Clearance times for HPV DNA and abnormal PAP test did not deviate from each other in either groups (Wilcoxon: P = 0.063 and P = 0.088). The monthly clearance rates for the abnormal PAP test are 1.32 and 1.38%, and those for the HPV DNA 1.62 and 1.61%, in Groups 1 and 2, respectively. Of the factors predicting the last visit clearance, the issues related to smoking are of particular interest. CONCLUSIONS The clearance of high-risk HPV type and abnormal PAP test shows a close temporal relationship, the former preceding the latter, however, by an interval of 1.0-2.0 months.
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Affiliation(s)
- S Syrjänen
- Department of Oral Pathology, Institute of Dentistry, and MediCity Research Laboratory, University of Turku 2, FIN-20520 Turku, Finland.
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Syrjänen S, Shabalova I, Petrovichev N, Kozachenko V, Zakharova T, Pajanidi J, Podistov J, Chemeris G, Sozaeva L, Lipova E, Tsidaeva I, Ivanchenko O, Pshepurko A, Zakharenko S, Nerovjna R, Kljukina L, Erokhina O, Branovskaja M, Nikitina M, Grunberga V, Grunberg A, Juschenko A, Cintorino M, Santopietro R, Tosi P, Syrjänen K. Factors predicting persistence of high-risk human papillomavirus (HPV) infections in women prospectively followed-up in three New Independent States (NIS) of the former Soviet Union. EUR J GYNAECOL ONCOL 2005; 26:491-8. [PMID: 16285563] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND We completed an analysis of the factors predicting the persistence of high risk (HR) HPV infections in women participating in a multicenter screening trial in three NIS countries. METHODS The 543 baseline HR HPV-positive women included in this analysis are derived from a sub-cohort of 887 women who were prospectively followed-up for a mean of 21.6 months (range: 0.5-42.9) as a part of a multi-center screening study in three NIS countries (the NIS cohort study; n = 3,187 women). Of these 543 women, 273 showed persistent HR-HPV in serial Hybrid Capture II (HCII) testing during the follow-up (Group 1), whereas 270 women cleared their infection (Group 2). These two groups were compared with their epidemiological, clinical, and virological data (HCII, PCR) to disclose the factors predicting persistent HR-HPV infection. RESULTS Women with persistent HR-HPV infections were significantly younger (27.3 yrs) than those who cleared their infection (29.1 yrs) (p = 0.006), and their follow-up time was shorter; 14.1 and 21 months, respectively (p = 0.0001). Both variables were treated as confounders in the multivariate analyses. Of the 66 recorded epidemiological variables, only being a current smoker proved to be an independent predictor (OR 1.693; 95% CI 1.114-2.573; p=0.014). Baseline colposcopy, biopsy or Pap smear did not predict HPV persistence, whereas an incident or persistent abnormal Pap during the follow-up were independent predictors in a multivariate model (p = 0.005), together with the high viral load (HCII RLU/CO at 100 pg/ml cut-off), and HR HPV positive PCR test (p = 0.0001). When all significant variables were entered in the regression model, only the follow-up time (OR 0.950, 95% CI 0.924-0.976; p = 0.0001) and HR-HPV positive PCR (OR 4.169, 95% CI 1.741-9.987; p = 0.001), remained independent predictors. CONCLUSIONS While several factors were related to HR-HPV persistence in univariate analysis and when adjusted for age and follow-up time as confounders, the only independent predictors in the multivariate regression model were follow-up time and HR-HPV positive PCR. Clearly more data are needed on type-specific persistence and HPV integration as its predictors.
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Affiliation(s)
- S Syrjänen
- Department of Oral Pathology, Institute of Dentistry, University of Turku, Finland
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