1
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Gross GE, Werner RN, Avila Valle GL, Bickel M, Brockmeyer NH, Doubek K, Gallwas J, Gieseking F, Haase H, Hillemanns P, Ikenberg H, Jongen J, Kaufmann AM, Klußmann JP, von Knebel Doeberitz M, Knuf M, Köllges R, Laws HJ, Mikolajczyk R, Neis KJ, Petry KU, Pfister H, Schlaeger M, Schneede P, Schneider A, Smola S, Tiews S, Nast A, Gaskins M, Wieland U. Evidenz‐ und konsensbasierte (S3) Leitlinie: Impfprävention HPV‐assoziierter Neoplasien. J Dtsch Dermatol Ges 2021; 19:479-494. [PMID: 33709591 DOI: 10.1111/ddg.14438_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Gerd E Gross
- Klinik für Dermatologie und Venerologie, Universitätsklinik Rostock, Rostock.,Paul-Ehrlich-Gesellschaft für Chemotherapie e.V., HPV Management Forum
| | - Ricardo N Werner
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, -corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin -Institute of Health, Berlin
| | - Gabriela L Avila Valle
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, -corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin -Institute of Health, Berlin
| | | | - Norbert H Brockmeyer
- Klinik für Dermatologie, Venerologie und Allergologie der Ruhr-Universität -Bochum, Zentrum für Sexuelle Gesundheit - WIR "Walk In Ruhr", Bochum
| | | | - Julia Gallwas
- Klinik für Gynäkologie und Geburtshilfe, Georg-August-Universität Göttingen
| | | | | | | | - Hans Ikenberg
- MVZ für Zytologie und Molekularbiologie Frankfurt GbR (CytoMol), Frankfurt am Main
| | | | - Andreas M Kaufmann
- Klinik für Gynäkologie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - Jens Peter Klußmann
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Uniklinik Köln, Medizinische Fakultät, Universität zu Köln
| | - Magnus von Knebel Doeberitz
- Abteilung für Angewandte Tumorbiologie, Institut für Pathologie, Universitätsklinikum Heidelberg und Klinische Kooperationseinheit G105 des Deutschen Krebsforschungszentrums (DKFZ)
| | - Markus Knuf
- Klinik für Kinder und Jugendliche, Helios Dr. Horst Schmidt Kliniken, Wiesbaden.,Pädiatrische Infektiologie, Universitätsmedizin Mainz, Mainz
| | - Ralf Köllges
- Praxis für Kinder und Jugendliche, Mönchengladbach
| | - Hans-Jürgen Laws
- Klinik für Kinderonkologie, -hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf
| | - Rafael Mikolajczyk
- Institut für Medizinische Epidemiologie, Biometrie und Informatik (IMEBI), Martin-Luther Universität Halle-Wittenberg, Halle (Saale)
| | | | | | | | | | | | | | - Sigrun Smola
- Institut für Virologie, Universitätsklinikum des Saarlandes, Medizinische Fakultät, Universität des Saarlandes, Homburg/Saar
| | - Sven Tiews
- MVZ Labor für Cytopathologie Dr. Steinberg GmbH, Soest
| | - Alexander Nast
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, -corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin -Institute of Health, Berlin
| | - Matthew Gaskins
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, -corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin -Institute of Health, Berlin
| | - Ulrike Wieland
- Nationales Referenzzentrum für Papillom- und Polyomaviren, Institut für Virologie, Uniklinik Köln, Universität zu Köln, Köln
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2
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Gross GE, Werner RN, Avila Valle GL, Bickel M, Brockmeyer NH, Doubek K, Gallwas J, Gieseking F, Haase H, Hillemanns P, Ikenberg H, Jongen J, Kaufmann AM, Klußmann JP, von Knebel Doeberitz M, Knuf M, Köllges R, Laws HJ, Mikolajczyk R, Neis KJ, Petry KU, Pfister H, Schlaeger M, Schneede P, Schneider A, Smola S, Tiews S, Nast A, Gaskins M, Wieland U. German evidence and consensus-based (S3) guideline: Vaccination recommendations for the prevention of HPV-associated lesions. J Dtsch Dermatol Ges 2021; 19:479-494. [PMID: 33634583 DOI: 10.1111/ddg.14438] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/10/2020] [Indexed: 11/28/2022]
Abstract
Anogenital and oropharyngeal infections with human papilloma viruses (HPV) are common. Clinically manifest disease may significantly impact quality of life; the treatment of HPV-associated lesions is associated with a high rate of recurrence and invasive neoplasms, such as cervical, anal, vulvar, penile, and oropharyngeal cancers, which are characterized by significant morbidity and mortality. Vaccination against HPV is an effective and safe measure for the primary prevention of HPV-associated lesions, but immunization rates are still low in Germany. The present publication is an abridged version of the German evidence and consensus-based guideline "Vaccination recommendations for the prevention of HPV-associated lesions", which is available on the website of the German Association of the Scientific Medical Societies (AWMF). On the basis of a systematic review with meta-analyses, a representative panel developed and agreed upon recommendations for the vaccination of different populations against HPV. In addition, consensus-based recommendations were developed for specific issues relevant to everyday practice. Based on current evidence and a representative expert consensus, these recommendations are intended to provide guidance in a field in which there is often uncertainty and in which both patients and health care providers are sometimes confronted with controversial and emotionally charged points of view.
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Affiliation(s)
- Gerd E Gross
- Department of Dermatology and Venereology, University Hospital Rostock, Rostock, Germany.,Paul Ehrlich Society for Chemotherapy, HPV Management Forum, Germany
| | - Ricardo N Werner
- Department of Dermatology, Venereology and Allergology, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - University Medical Center Berlin, corporate member of Free University Berlin, Humboldt University Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gabriela L Avila Valle
- Department of Dermatology, Venereology and Allergology, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - University Medical Center Berlin, corporate member of Free University Berlin, Humboldt University Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Markus Bickel
- Infektiologikum Frankfurt, Frankfurt am Main, Germany
| | - Norbert H Brockmeyer
- Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Center for Sexual Health - WIR "Walk In Ruhr", Bochum, Germany
| | - Klaus Doubek
- Gynecology Office Dr. Klaus Doubek, Wiesbaden, Germany
| | - Julia Gallwas
- Department of Gynecology and Obstetrics, Georg August University Göttingen, Göttingen, Germany
| | | | | | - Peter Hillemanns
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Hans Ikenberg
- MVZ for Cytology and Molecular Biology (CytoMol), Frankfurt am Main, Germany
| | | | - Andreas M Kaufmann
- Department of Gynecology, Campus Virchow Hospital, Charité - University Medical Center Berlin, corporate member of Free University Berlin, Humboldt University Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jens Peter Klußmann
- Department of Otorhinolaryngology, Head and Neck Surgery, -University Hospital of Cologne, Medical Faculty, University of Cologne, Cologne, Germany
| | - Magnus von Knebel Doeberitz
- Department of Applied Tumor Biology, Institute of Pathology, University Hospital Heidelberg, Clinical Cooperation Unit G105 of the German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Markus Knuf
- Hospital for Child and Adolescent Health, Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany.,Pediatric Infectiology, University Medical Center Mainz, Mainz, Germany
| | - Ralf Köllges
- Office for Child and Adolescent Health, Mönchengladbach, Germany
| | - Hans-Jürgen Laws
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biometry and Informatics (IMEBI), Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - Klaus J Neis
- Gynecology Office am Staden, Saarbrücken, Germany
| | | | - Herbert Pfister
- Institute of Virology, University of Cologne, Cologne, Germany
| | | | | | | | - Sigrun Smola
- Institute of Virology, Saarland University Medical Center, Medical Faculty, Saarland University, Homburg/Saar, Germany
| | - Sven Tiews
- MVZ Laboratory for Cytopathology Dr. Steinberg GmbH, Soest, Germany
| | - Alexander Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - University Medical Center Berlin, corporate member of Free University Berlin, Humboldt University Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Matthew Gaskins
- Department of Dermatology, Venereology and Allergology, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - University Medical Center Berlin, corporate member of Free University Berlin, Humboldt University Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ulrike Wieland
- National Reference Center for Papilloma and Polyoma Viruses, Institute of Virology, University Hospital of Cologne, University of Cologne, Cologne, Germany
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3
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Schöfer H, Enders M, Esser S, Feiterna-Sperling C, Hagedorn HJ, Magistro G, Mayr C, Münstermann D, Hahn K, Jansen K, Klein M, Krause W, Maschke M, Ochsendorf FR, Osowski S, Petry KU, Potthoff A, Rieg S, Sing A, Stücker M, Weberschock T, Werner RN, Brockmeyer NH. [Diagnosis and treatment of syphilis : Update of the S2k guidelines 2020 of the German STI Society (DSTIG) in cooperation with the following specialist societies: DAIG, dagnä, DDG, DGA, DGGG, DGHM, DGI, DGN, DGPI, DGU, RKI]. Hautarzt 2021; 71:969-999. [PMID: 32940778 DOI: 10.1007/s00105-020-04672-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H Schöfer
- Helios Dr. Horst Schmidt Kliniken, Deutsche Klinik für Diagnostik, Aukamm-Allee 33, 65191, Wiesbaden, Deutschland.
| | - M Enders
- Labor Prof. Gisela Enders & Kollegen MVZ Stuttgart, Stuttgart, Deutschland
| | - S Esser
- Leiter der HIV/STD-Ambulanz, Klinik für Dermatologie und Venerologie, Universitätsklinikum Essen, Essen, Deutschland
| | - C Feiterna-Sperling
- Klinik für Pädiatrie m. S. Pneumologie, Immunologie und Intensivmedizin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | | | - G Magistro
- Urologische Klinik, Ludwig-Maximilians-Universität München, München, Deutschland
| | - C Mayr
- Facharzt für Innere Medizin/Infektiologie, Hausärztliche Betreuung, Zentrum für Infektiologie Berlin, Prenzlauer Berg (ZIBP), MVZ, Berlin, Deutschland
| | | | - K Hahn
- Klinik für Neurologie, Universitätsmedizin Charité, Campus Charité Mitte, Berlin, Deutschland
| | - K Jansen
- Abteilung für Infektionsepidemiologie, Fachgebiet für HIV/AIDS und andere sexuell oder durch Blut übertragbare Infektionen, Robert Koch-Institut, Berlin, Deutschland
| | - M Klein
- Abteilung: Neurologische Klinik, Ludwig-Maximilians-Universität München, Klinikum Großhadern, München, Deutschland
| | - W Krause
- Hautklinik der Philipps-Universität, Marburg, Deutschland
| | - M Maschke
- Abteilung: Neurologie, Neurophysiologie und neurologische Frührehabilitation, MVZ der Barmherzigen Brüder Trier, Sektion Neurologie, Psychiatrie, Trier, Deutschland
| | - F R Ochsendorf
- Klinik für Dermatologie, Venerologie und Allergologie (KDVA), Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - S Osowski
- Klinik f. Dermatologie, Venerologie und Allergologie (KDVA) und Evidenzbasierte Medizin, Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt, Deutschland
| | - K U Petry
- Frauenklinik, Klinikum der Stadt Wolfsburg, Wolfsburg, Deutschland
| | - A Potthoff
- WIR "Walk In Ruhr" im St. Elisabeth-Hospital, Bochum, Deutschland
| | - S Rieg
- Abteilung Infektiologie, Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - A Sing
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Oberschleißheim, Deutschland
| | - M Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - T Weberschock
- Klinik f. Dermatologie, Venerologie und Allergologie (KDVA) und Evidenzbasierte Medizin, Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt, Deutschland
| | - R N Werner
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - N H Brockmeyer
- WIR "Walk In Ruhr" im St. Elisabeth-Hospital, Bochum, Deutschland
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4
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Ramachandran D, Schürmann P, Mao Q, Wang Y, Bretschneider LM, Speith LM, Hülse F, Enßen J, Bousset K, Jentschke M, Böhmer G, Strauß HG, Hirchenhain C, Schmidmayr M, Tarbiat J, Runnebaum I, Dürst M, Hein A, Koch M, Ruebner M, Ekici A, Beckmann MW, Fasching PA, Luyten A, Petry KU, Hillemanns P, Dörk T. Association of genomic variants at the human leukocyte antigen locus with cervical cancer risk, HPV status and gene expression levels. Int J Cancer 2020; 147:2458-2468. [PMID: 32580243 DOI: 10.1002/ijc.33171] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/15/2020] [Accepted: 05/25/2020] [Indexed: 12/17/2022]
Abstract
The human leukocyte antigen (HLA) locus on chromosome 6 has been reported to be associated with cervical cancer. We investigated two independent single-nucleotide polymorphisms in a large case-control series of cervical dysplasia and carcinoma that has been newly established by the German Cervigen Consortium, comprising a total of 2481 cases and 1556 healthy females. We find significant associations for both variants, rs9272117 at HLA-DQA1 and rs2844511 at MICA and HCP5, with cervical disease. Both variants showed evidence of association with invasive cervical cancer (rs9272117: OR 0.89, 95% CI 0.79-0.99, P = .036; rs2844511: OR 1.17, 95% CI 1.04-1.31, P = .008) and with high-grade dysplasia (rs9272117: OR 0.78, 95% CI 0.70-0.87, P = 7.1 × 10-6 ; rs2844511: OR 1.13, 95% CI 1.01-1.26, P = .035), as well as in a combined analysis of both groups (rs9272117: OR 0.83, 95% CI 0.75-0.91, P = 6.9 × 10-5 ; rs2844511: OR 1.14, 95% CI 1.04-1.26, P = .005). Variant rs2844511, but not rs9272117, also showed modest evidence of association with low-grade dysplasia (OR 1.26, 95% CI 1.04-1.54, P = .019). In case-only analyses, rs2844511 tended to predict HPV status (P = .044) and rs9272117 tended to associate with HPV16 (P = .022). RNA studies in cervical samples showed a significant correlation in the transcript levels of MICA, HCP5 and HLA-DQA1, suggesting extensive co-regulation. All three genes were upregulated in HPV16-positive samples. In stratified analyses, rs9272117 was associated with HLA-DQA1 levels, specifically in HPV-positive samples, while rs2844511 was associated with MICA and HCP5 levels. The risk allele of rs2844511 was required for correlations between MICA or HCP5 with HLA-DQA1. Altogether, our results support 6p21.32-33 as the first consistent cervical cancer susceptibility locus and provide evidence for a link between genetic risk variants, HPV16 status and transcript levels of HLA-DQA1, HCP5 and MICA, which may contribute to tumor immune evasion.
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Affiliation(s)
- Dhanya Ramachandran
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Peter Schürmann
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Qianqian Mao
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Yingying Wang
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Lisa-Marie Bretschneider
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Lisa-Marie Speith
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Fabienne Hülse
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Julia Enßen
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Kristine Bousset
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Matthias Jentschke
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | | | - Hans-Georg Strauß
- Department of Gynaecology, University Clinics, Martin-Luther University, Halle-Wittenberg, Germany
| | - Christine Hirchenhain
- Department of Gynaecology, Clinics Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - Monika Schmidmayr
- Department of Gynaecology, Technische Universität München, Munich, Germany
| | | | - Ingo Runnebaum
- Department of Gynecology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matthias Dürst
- Department of Gynecology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Martin Koch
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Arif Ekici
- Institute of Human Genetics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Alexander Luyten
- Dysplasia Unit, Department of Gynecology and Obstetrics, Mare Klinikum, Kronshagen, Germany.,Department of Gynecology, Wolfsburg Hospital, Wolfsburg, Germany
| | | | - Peter Hillemanns
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Thilo Dörk
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
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5
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Hasenburg A, Sehouli J, Lampe B, Reuss A, Schmalfeldt B, Belau A, Bossart M, Mahner S, Hillemanns P, Petry KU, du Bois A, Herwig U, Hilpert F, Gropp-Meier M, Hanf V, Janni W, Schindelhauer A, Kimmig R, Greimel E, Wagner U, Harter P. LION-PAW – Lymphonodectomy (LNE) in Ovarian Neoplasm – Pleasure Ability of Women Prospektive Substudie der multizentrischen AGO LION Studie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- A Hasenburg
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Deutschland
| | - J Sehouli
- Charité, Campus Virchow Klinikum, Berlin, Deutschland
| | - B Lampe
- Kaiserswerther Diakonie/Florence Nightingale Krankenhaus, Düsseldorf, Deutschland
| | - A Reuss
- Philipps-University of Marburg, Coordinating Center for Clinical Trials, Marburg, Deutschland
| | - B Schmalfeldt
- Klinikum rechts der Isar; Technical University of Munich, München, Deutschland
- University Medical Center Hamburg-Eppendorf, Dept. of Gynecology and Gynecologic Oncology, Hamburg, Deutschland
| | - A Belau
- University of Greifswald, Clinic and Policlinic for Gynecology and Obstetrics, Greifswald, Deutschland
| | - M Bossart
- Universitätsklinik Freiburg, Universitätsfrauenklinik, Freiburg, Deutschland
| | - S Mahner
- University Medical Center Hamburg-Eppendorf, Dept. of Gynecology and Gynecologic Oncology, Hamburg, Deutschland
- Universitätsfrauenklinik LMU München, Geburtshilfe und Frauenheilkunde, München, Deutschland
| | - P Hillemanns
- Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe, Hannover, Deutschland
| | - KU Petry
- Klinikum Wolfsburg, Frauenklinik, Wolfsburg, Deutschland
| | - A du Bois
- Kliniken Essen-Mitte (KEM) Evang. Huyssens-Stiftung/Knappschaft GmbH, Klinik für Gynäkologie und gyn. Onkologie, Essen, Deutschland
| | - U Herwig
- Albertinen-Hospital Hamburg, Research Center Gynecology, Hamburg, Deutschland
| | - F Hilpert
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - M Gropp-Meier
- Oberschwabenklinik, Krankenhaus St. Elisabeth, Ravensburg, Deutschland
| | - V Hanf
- Klinikum Fürth, Frauenklinik, Fürth, Deutschland
| | - W Janni
- University of Ulm, Department of Gynecology, Ulm, Deutschland
| | - A Schindelhauer
- Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - R Kimmig
- Universitätsklinikum Essen, Frauenklinik, Essen, Deutschland
| | - E Greimel
- Medical University Graz, Department of Obstetrics and Gynecology, Graz, Österreich
| | - U Wagner
- University of Gießen and Marburg GmbH Site Marburg, Klinik für Gynäkologie, Gyn. Endokrinologie und Onkologie, Marburg, Deutschland
| | - P Harter
- Kliniken Essen-Mitte (KEM) Evang. Huyssens-Stiftung/Knappschaft GmbH, Klinik für Gynäkologie und gyn. Onkologie, Essen, Deutschland
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6
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de Gregorio N, du Bois A, Sehouli J, Reuss A, Burges A, Kimmig R, Hilpert F, Hasenburg A, Hillemanns P, Leffern I, Gropp-Maier M, Petry KU, Schindelhauer A, Rothmund R, Zivanovic O, Kullmer U, Hanf V, Emons G, Wager U, Harter P. Die Lion Studie: Lymphadenektomie beim fortgeschrittenen primären Ovarialkarzinom – Eine multinationale randomisiert-prospektive Studie der AGO. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
| | - A du Bois
- Kliniken Essen-Mitte (KEM) Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Deutschland
| | - J Sehouli
- Charité Universitätsklinikum, Campus Virchow-Klinikum, Berlin, Deutschland
| | - A Reuss
- KKS Marburg, Marburg, Deutschland
| | - A Burges
- LMU München, München, Deutschland
| | - R Kimmig
- Universitätsklinikum Essen, Essen, Deutschland
| | - F Hilpert
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | | | - P Hillemanns
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | - I Leffern
- Albertinenkrankenhaus, Hamburg, Deutschland
| | - M Gropp-Maier
- Elisabethenkrankenhaus Ravensburg, Ravensburg, Deutschland
| | - KU Petry
- Klinikum Wolfsburg, Wolfsburg, Deutschland
| | | | - R Rothmund
- Unifrauenklinik Tübingen, Tübingen, Deutschland
| | | | | | - V Hanf
- Klinikum Fürth, Fürth, Deutschland
| | - G Emons
- Unifrauenklinik Göttingen, Göttingen, Deutschland
| | - U Wager
- Unifrauenklinik Marburg, Marburg, Deutschland
| | - P Harter
- Kliniken Essen Mitte, Essen, Deutschland
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Petry KU, Bollaerts K, Bonanni P, Stanley M, Drury R, Joura E, Kjaer SK, Meijer CJLM, Riethmuller D, Soubeyrand B, Van Damme P, Bosch X. Estimation of the individual residual risk of cervical cancer after vaccination with the nonavalent HPV vaccine. Hum Vaccin Immunother 2018; 14:1800-1806. [PMID: 29553886 PMCID: PMC6067852 DOI: 10.1080/21645515.2018.1450125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The nonavalent HPV (9vHPV) vaccine is indicated for active immunisation of individuals from the age of 9 years against cervical, vulvar, vaginal and anal premalignant lesions and cancers causally related to vaccine HPV high risk types 16, 18, 31, 33, 45, 52 and 58, and to the HPV low risk types 6 and 11, causing genital warts. OBJECTIVE To estimate the lifetime risk (up to the age of 75 years) for developing cervical cancer after vaccinating a HPV naïve girl (e.g. 9 to 12 years old) with the 9vHPV vaccine in the hypothetical absence of cervical cancer screening. METHODS We built Monte Carlo simulation models using historical pre-screening age-specific cancer incidence data and current mortality data from Denmark, Finland, Norway, Sweden and the UK. Estimates of genotype contribution fractions and vaccine efficacy were used to estimate the residual lifetime risk after vaccination assuming lifelong protection. RESULTS We estimated that, in the hypothetical absence of cervical screening and assuming lifelong protection, 9vHPV vaccination reduced the lifetime cervical cancer and mortality risks 7-fold with a residual lifetime cancer risks ranging from 1/572 (UK) to 1/238 (Denmark) and mortality risks ranging from 1/1488 (UK) to 1/851 (Denmark). After decades of repetitive cervical screenings, the lifetime cervical cancer and mortality risks was reduced between 2- and 4-fold depending on the country. CONCLUSION Our simulations demonstrate how evidence can be generated to support decision-making by individual healthcare seekers regarding cervical cancer prevention.
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Affiliation(s)
- Karl-Ulrich Petry
- a Department of Gynaecology and Obstetrics , Klinikum Wolfsburg , Germany
| | | | - Paolo Bonanni
- c Department of Health Sciences , University of Florence , Italy
| | - Margaret Stanley
- d Department of Pathology , Cambridge University , United Kingdom
| | | | - Elmar Joura
- f Department of Obstetrics and Gynaecology , Comprehensive Cancer Centre Vienna, Medical University of Vienna , Austria
| | - Susanne K Kjaer
- g Department of Gynaecology, Rigshospitalet , Copenhagen University Hospital and the Danish Cancer Society Research Centre , Copenhagen , Denmark
| | - Chris J L M Meijer
- h Department of Pathology , Free University Medical Centre , Netherlands
| | | | | | - Pierre Van Damme
- j Centre for Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp , Belgium
| | - Xavier Bosch
- k Cancer Research Epidemiology Program, Catalan Institute of Oncology, IDIBELL , Spain
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Hasenburg A, Sehouli J, Lampe B, Reuss A, Schmalfeldt B, Belau AK, Bossart M, Mahner S, Hillemanns P, Petry KU, Du Bois A, Herwig U, Hilpert F, Gropp-Meier M, Hanf V, Janni W, Greimel E, Wagner UAG, Harter P. LION-PAW: Lymphadenectomy in ovarian neoplasm-pleasure ability of women—Prospective substudy of the randomized multicenter LION study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jalid Sehouli
- AGO and Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Boern Lampe
- AGO and Kaiserswerther Diakonie, Duesseldorf, Germany
| | - Alexander Reuss
- AGO and Coordinating Center for Clinical Trials, Marburg, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Muenchen, Germany, Muenchen, Germany
| | - Antje Kristina Belau
- Ernst Moritz Arndt Universität Greifswald - Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Greifswald, Germany
| | | | - Sven Mahner
- Ludwig-Maximilians-Universität München and University Medical Center Hamburg-Eppendorf, Germany, Munich, Germany
| | - Peter Hillemanns
- Hannover Medical School, Department of Obstetrics and Gynecology, Breast Center, Hannover, Germany
| | | | | | - Uwe Herwig
- Albertinen-Krankenhaus, Hamburg, Germany
| | - Felix Hilpert
- Onkologisches Therapiezentrum am Krankenhaus Jerusalem, Hamburg, Germany
| | | | - Volker Hanf
- Department of Gynecology, Fuerth Hospital, Fuerth, Germany
| | | | - Elfriede Greimel
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
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Petry KU, Horn J, Luyten A, Mikolajczyk RT. Punch biopsies shorten time to clearance of high-risk human papillomavirus infections of the uterine cervix. BMC Cancer 2018; 18:318. [PMID: 29566658 PMCID: PMC5865384 DOI: 10.1186/s12885-018-4225-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background The primary objective was to determine human papilloma virus (HPV) clearance rate after cervical biopsy among women with persistent high-risk HPV infection compared with spontaneous HPV clearance rate in the absence of biopsy. Methods We collected data from a dedicated screening program of women aged 30–70 years old. Inclusion criteria for the baseline non-interventional cohort were a positive HPV test (hybrid capture 2, HC2) and normal cytology. In the baseline cohort women were followed with approximately yearly HPV-tests and cytology until HPV regressed (one negative HPV test) or interventions in the form of diagnostic biopsies or therapy. Women who had a diagnostic biopsy were included in the biopsy cohort and followed until HPV regression or therapy. Observed HPV regression rates and time to HPV regression were compared between baseline and biopsy cohorts. For the comparison, we used Fisher’s exact test for the HPV regression rates and interval-censored, accelerated failure time model for time to HPV regression. Results Among the 1079 women included in the baseline cohort, 499 (46.3%) had HPV clearance and 475 were referred for colposcopy with biopsy. The biopsy cohort comprised all women who were not treated and had at least one HC2 test after biopsy (201/475; 42.3%). Of those, 138 (68.7%) experienced HPV regression. In the biopsy cohort, time to clearance of HPV infection was approximately halved (0.46, 95% CI 0.38–0.56) compared with the baseline cohort. This result was robust in a wide range of sensitivity analyses. Conclusions A higher proportion of women cleared their HPV infection, and time to HPV clearance was shorter in the biopsy cohort than in the baseline cohort. It is reassuring for clinicians to know that conservative management of patients with HPV persistency is successful when colposcopy with biopsies excludes high-grade disease.
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Affiliation(s)
- K U Petry
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany.
| | - J Horn
- Institute for Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - A Luyten
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - R T Mikolajczyk
- Institute for Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany.,Hannover Medical School, Hannover, Germany.,German Centre for Infection Research/ Site Braunschweig-Hannover, Braunschweig, Germany
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Arbyn M, Redman CWE, Verdoodt F, Kyrgiou M, Tzafetas M, Ghaem-Maghami S, Petry KU, Leeson S, Bergeron C, Nieminen P, Gondry J, Reich O, Moss EL. Incomplete excision of cervical precancer as a predictor of treatment failure: a systematic review and meta-analysis. Lancet Oncol 2017; 18:1665-1679. [PMID: 29126708 DOI: 10.1016/s1470-2045(17)30700-3] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/24/2017] [Accepted: 08/29/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Incomplete excision of cervical precancer is associated with therapeutic failure and is therefore considered as a quality indicator of clinical practice. Conversely, the risk of preterm birth is reported to correlate with size of cervical excision and therefore balancing the risk of adequate treatment with iatrogenic harm is challenging. We reviewed the literature with an aim to reveal whether incomplete excision, reflected by presence of precancerous tissue at the section margins, or post-treatment HPV testing are accurate predictors of treatment failure. METHODS We did a systematic review and meta-analysis to assess the risk of therapeutic failure associated with the histological status of the margins of the tissue excised to treat cervical precancer. We estimated the accuracy of the margin status to predict occurrence of residual or recurrent high-grade cervical intraepithelial neoplasia of grade two or worse (CIN2+) and compared it with post-treatment high-risk human papillomavirus (HPV) testing. We searched for published systematic reviews and new references from PubMed-MEDLINE, Embase, and CENTRAL and did also a new search spanning the period Jan 1, 1975, until Feb 1, 2016. Studies were eligible if women underwent treatment by excision of a histologically confirmed CIN2+ lesion, with verification of presence or absence of CIN at the resection margins; were tested by cytology or HPV assay between 3 months and 9 months after treatment; and had subsequent follow-up of at least 18 months post-treatment including histological confirmation of the occurrence of CIN2+. Primary endpoints were the proportion of positive section margins and the occurrence of treatment failure associated with the marginal status, in which treatment failure was defined as occurrence of residual or recurrent CIN2+. Information about positive resection margins and subsequent treatment failure was pooled using procedures for meta-analysis of binomial data and analysed using random-effects models. FINDINGS 97 studies were eligible for inclusion in the meta-analysis and included 44 446 women treated for cervical precancer. The proportion of positive margins was 23·1% (95% CI 20·4-25·9) overall and varied by treatment procedure (ranging from 17·8% [12·9-23·2] for laser conisation to 25·9% [22·3-29·6] for large loop excision of the transformation zone) and increased by the severity of the treated lesion. The overall risk of residual or recurrent CIN2+ was 6·6% (95% CI 4·9-8·4) and was increased with positive compared with negative resection margins (relative risk 4·8, 95% CI 3·2-7·2). The pooled sensitivity and specificity to predict residual or recurrent CIN2+ was 55·8% (95% CI 45·8-65·5) and 84·4% (79·5-88·4), respectively, for the margin status, and 91·0% (82·3-95·5) and 83·8% (77·7-88·7), respectively, for high-risk HPV testing. A negative high-risk HPV test post treatment was associated with a risk of CIN2+ of 0·8%, whereas this risk was 3·7% when margins were free. INTERPRETATION The risk of residual or recurrent CIN2+ is significantly greater with involved margins on excisional treatment; however, high-risk HPV post-treatment predicts treatment failure more accurately than margin status. FUNDING European Federation for Colposcopy and Institut national du Cancer (INCA).
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium.
| | | | - Freija Verdoodt
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Kyrgiou
- Division of Reproductive Biology, Department Cancer and Surgery, Imperial College, London, UK
| | - Menelaos Tzafetas
- Division of Reproductive Biology, Department Cancer and Surgery, Imperial College, London, UK
| | - Sadaf Ghaem-Maghami
- Division of Reproductive Biology, Department Cancer and Surgery, Imperial College, London, UK
| | - Karl-Ulrich Petry
- Department of Gynaecology and Obstetrics, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Simon Leeson
- Department of Gynaecology and Obstetrics, Betsi Cadwaladr University Health Board, Bangor, Gwyndd, UK
| | | | - Pekka Nieminen
- Department of Gynaecology and Obstetrics, Helsinki University Hospital, Helsinki, Finland
| | - Jean Gondry
- Service de gynécologie et obstétrique, CHU d'Amiens-Picardie, Amiens, France
| | - Olaf Reich
- Department of Gynaecology and Obstetrics, Medical University of Graz, Graz, Austria
| | - Esther L Moss
- Department of Cancer Studies, University of Leicester, Leicester, UK
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Luyten A, Strehlke S, Weiß V, Iftner A, Iftner T, Petry KU. WOLVES – impact of HPV vaccination in Wolfsburg, Germany. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Luyten A, Mikolajczyk RT, Horn J, Petry KU. Accelerated regression rates of cervical high-risk human papillomavirus infections by punch biopsies of the uterine cervix. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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13
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Luyten A, Strehlke S, Iftner A, Iftner T, Petry KU. HPV clearance and persistency in young women – five years follow of WOLVES- study. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Luyten A, Strehlke S, Rothe B, Petry KU. Comparison of Anyplex II HPV HR- and Hybrid Capture2 testing in a screening population (WOLPHSCREEN). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Van Damme P, Bonanni P, Bosch FX, Joura E, Kjaer SK, Meijer CJLM, Petry KU, Soubeyrand B, Verstraeten T, Stanley M. Corrigendum to "Use of the nonavalent HPV vaccine in individuals previously fully or partially vaccinated with bivalent or quadrivalent HPV vaccines" [Vaccine 34 (2016) 757-761]. Vaccine 2016; 34:4759-4760. [PMID: 27461456 DOI: 10.1016/j.vaccine.2016.07.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Pierre Van Damme
- Centre for Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium.
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - F Xavier Bosch
- Cancer Research Epidemiology Program, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain
| | - Elmar Joura
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Susanne Krüger Kjaer
- Department of Gynaecology, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital and the University of Copenhagen, Copenhagen, Denmark
| | - Chris J L M Meijer
- Department of Pathology, Free University Medical Center, Amsterdam, The Netherlands
| | - Karl-Ulrich Petry
- Department of Gynaecology and Obstetrics, Klinikum Wolfsburg, Wolfsburg, Germany
| | | | - Thomas Verstraeten
- P95, Epidemiology and Pharmacovigilance Consulting and Services, Leuven, Belgium
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Bosch FX, Robles C, Díaz M, Arbyn M, Baussano I, Clavel C, Ronco G, Dillner J, Lehtinen M, Petry KU, Poljak M, Kjaer SK, Meijer CJLM, Garland SM, Salmerón J, Castellsagué X, Bruni L, de Sanjosé S, Cuzick J. HPV-FASTER: broadening the scope for prevention of HPV-related cancer. Nat Rev Clin Oncol 2016; 13:119-32. [PMID: 26323382 DOI: 10.1038/nrclinonc.2015.146] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Human papillomavirus (HPV)-related screening technologies and HPV vaccination offer enormous potential for cancer prevention, notably prevention of cervical cancer. The effectiveness of these approaches is, however, suboptimal owing to limited implementation of screening programmes and restricted indications for HPV vaccination. Trials of HPV vaccination in women aged up to 55 years have shown almost 90% protection from cervical precancer caused by HPV16/18 among HPV16/18-DNA-negative women. We propose extending routine vaccination programmes to women of up to 30 years of age (and to the 45-50-year age groups in some settings), paired with at least one HPV-screening test at age 30 years or older. Expanding the indications for HPV vaccination and much greater use of HPV testing in screening programmes has the potential to accelerate the decline in cervical cancer incidence. Such a combined protocol would represent an attractive approach for many health-care systems, in particular, countries in Central and Eastern Europe, Latin America, Asia, and some more-developed parts of Africa. The role of vaccination in women aged >30 years and the optimal number of HPV-screening tests required in vaccinated women remain important research issues. Cost-effectiveness models will help determine the optimal combination of HPV vaccination and screening in public health programmes, and to estimate the effects of such approaches in different populations.
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Affiliation(s)
- F Xavier Bosch
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Claudia Robles
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Mireia Díaz
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | | | - Christine Clavel
- Centre Hospitalier Universitaire (CHU) Reims, Université de Reims Champagne-Ardenne and Institut National de la Santé et de la Recherche Médicale UMR-S 903, Reims, France
| | - Guglielmo Ronco
- Unit of Cancer Epidemiology, Centre for Cancer Prevention (CPO), Torino, Italy
| | - Joakim Dillner
- Departments of Laboratory Medicine, Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Matti Lehtinen
- University of Tampere, School of Health Sciences, Tampere, Finland
| | - Karl-Ulrich Petry
- Department of Obstetrics and Gynaecology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Susanne K Kjaer
- Virus, Lifestyle &Genes, Danish Cancer Society Research Centre; and Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Chris J L M Meijer
- Department of Pathology, VU University Medical Centre (VUmc), Amsterdam, Netherlands
| | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital; Murdoch Childrens Research Institute; and Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Jorge Salmerón
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Xavier Castellsagué
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Laia Bruni
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Silvia de Sanjosé
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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Luyten A, Petry KU. Relevance of HPV Screening for Triaging Equivocal Cytology Findings in the Pap II-p, Pap III and Pap IIID Groups - Results of Two Long-Term Studies. Geburtshilfe Frauenheilkd 2015; 75:1058-1062. [PMID: 26556908 DOI: 10.1055/s-0035-1557841] [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: 10/22/2022] Open
Abstract
Introduction: The use of HPV screening for the triage of ASC-US (atypical squamous cells of undetermined significance) cytology results has been established as a sound standard by international trials whereas the data for other cytology findings are in part contradictory. There is a lack of long-term studies on the use of HPV triage in Germany. Materials and Methods: For the present study data from a primary HPV screening project involving women aged over 30 years, ongoing since 2006, and an epidemiological study on women aged between 20 and 27 years, ongoing since 2009, were used. Upon recruitment, all women underwent a smear test for cytology and screening for "high-risk" HPV using Hybrid Capture 2 (HC2). If both tests were positive or if there were persisting remarkable cytology findings or a positive HPV test, then clarification by colposcopy was performed. Results: Altogether, among 282 women with Pap II-p (ASC-US), Pap III (ASC-H) or Pap IIID (LSIL + CIN2) and negative HPV test there was no case of CIN3+. Among the women under 30 years of age, however, 69 % (ASC-US) to 85 % (LSIL + CIN2) of the remarkable findings were HPV positive, also among the older women with Pap IIID, the 71 % prevalence of HPV was too high for a triage and even without triage there was a 23 % risk for CIN3+. On the other hand, of the women over 30 years old with ASC-US (Pap II-p) findings, only 21 % were positive for HPV and the risk for CIN3+ in this group was high at 29 %. Also for ASC-H (Pap III) findings in the age group of over 30 years with an HPV prevalence of 56 % there was an efficient triage for CIN3+. Discussion: In summary, the HPV triage of ASC-US (Pap II-p) findings in women aged over 30 years was found to be efficient; in contrast, LSIL + CIN2 (Pap IIID) findings in this age group justified an immediate referral to colposcopy whereas cytology control appeared to be sufficient for younger women.
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Affiliation(s)
- A Luyten
- Frauenklinik im Klinikum Wolfsburg, Wolfsburg
| | - K U Petry
- Frauenklinik im Klinikum Wolfsburg, Wolfsburg
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Luyten A, Strehlke S, Luyten K, Iftner A, Iftner T, Petry KU. WOLVES – Genotypenspezifisches Modell der HPV-Clearance und -Persistenz bei jungen Frauen in Wolfsburg. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Luyten A, Hastor H, Luyten K, Petry KU. Detektionen nicht-zervikaler Dysplasien und Karzinome im Rahmen eines primären HPV Screenings. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Luyten A, Luyten K, Strehlke S, Petry KU. WOLPHSCREEN – Klinischer Verlauf neu erworbener HPV-Infektionen bei Frauen ab 35 Jahren. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Hillemanns P, Petry KU, Soergel P, Collinet P, Ardaens K, Gallwas J, Luyten A, Dannecker C. Efficacy and safety of hexaminolevulinate photodynamic therapy in patients with low-grade cervical intraepithelial neoplasia. Lasers Surg Med 2014; 46:456-61. [PMID: 24799181 DOI: 10.1002/lsm.22255] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Non-surgical therapies are needed to reduce the rate of progression of low-grade cervical intraepithelial neoplasia (CIN 1) to high grade CIN (CIN 2/3). The aim of this study was to assess the efficacy and safety of hexaminolevulinate (HAL) photodynamic therapy (PDT) in the treatment of patients with CIN 1. STUDY DESIGN This phase IIa prospective double-blind study randomized patients with CIN 1 into three groups: HAL vaginal suppository, placebo vaginal suppository or follow-up only. Patients in the first two groups received HAL or placebo suppositories 5 hours before illumination with 50 J/cm(2) red coherent light (633 nm) using a special light catheter. All patients had a follow up including colposcopy, cytology and human papilloma virus (HPV) testing 3 and 6 months and additional biopsy 6 months after PDT. The main outcome measure was efficacy, defined as complete histologic remission 6 months after PDT. Secondary outcomes were histologic remission 3 months and HPV eradication 6 months after first PDT. RESULTS Seventy patients were randomized: 47 to HAL, 12 to placebo, 11 to follow up only. After 6 months CIN lesions had cleared in 57% of patients in the HAL-PDT group compared to 25% in the combined control group (per protocol population, P = 0.04). Twenty-six patients (37%) reported 44 adverse events (AEs), of which 40 were mild or moderate. Nineteen treatment-related AEs were reported by 15 patients (32%) in the HAL PDT group, one in the placebo PDT group (8%), and none in the follow-up group. The most common adverse events were local discomfort including mild pain/cramping (11) and leucorrhoea (2). CONCLUSION HAL PDT shows a favorable efficacy and safety profile and represents a promising alternative to observation and surgical procedures in patients with CIN 1.
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Affiliation(s)
- Peter Hillemanns
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
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22
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Gross G, Becker N, Brockmeyer NH, Esser S, Freitag U, Gebhardt M, Gissmann L, Hillemanns P, Grundhewer H, Ikenberg H, Jessen H, Kaufmann A, Klug S, Klußmann JP, Nast A, Pathirana D, Petry KU, Pfister H, Röllinghof U, Schneede P, Schneider A, Selka E, Singer S, Smola S, Sporbeck B, von Knebel Doeberitz M, Wutzler P. Vaccination against HPV-Associated Neoplasias: Recommendations from the Current S3 Guideline of the HPV Management Forum of the Paul-Ehrlich Society - AWMF Guidelines, Registry No. 082-002 (short version), valid until Dec. 31st, 2018. Geburtshilfe Frauenheilkd 2014; 74:233-241. [PMID: 27064858 DOI: 10.1055/s-0033-1360170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- G Gross
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin, Universität Rostock, Rostock
| | - N Becker
- Deutsches Krebsforschungszentrum (DKFZ), Epidemiologie von Krebserkrankungen (C020), Heidelberg
| | - N H Brockmeyer
- Klinik für Dermatologie und Allergologie der Ruhr-Universität, Bochum
| | - S Esser
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Essen, Essen
| | | | | | - L Gissmann
- Deutsches Krebsforschungszentrum (DKFZ), FS Infektion und Krebs, Heidelberg
| | - P Hillemanns
- Medizinische Hochschule Hannover (MHH), Frauenklinik, Abt. I für Frauenheilkunde und Geburtshilfe, Hannover
| | - H Grundhewer
- Ausschuss Prävention des Berufsverbandes der Kinder- und Jugendärzte (BVKJ), Berlin
| | - H Ikenberg
- MVZ für Zytologie und Molekularbiologie (CytoMol), Frankfurt/M
| | - H Jessen
- Praxis Jessen + Kollegen, Berlin
| | - A Kaufmann
- Gynäkologische Tumorimmunologie, Gynäkologie mit Hochschulambulanz, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
| | - S Klug
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
| | - J P Klußmann
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Universität Gießen, Gießen
| | - A Nast
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Allergologie und Venerologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin
| | - D Pathirana
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Allergologie und Venerologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin
| | - K U Petry
- Klinikum Wolfsburg, Abteilung Gynäkologische Onkologie, Wolfsburg
| | - H Pfister
- Institut für Virologie der Universität zu Köln
| | | | - P Schneede
- Klinikum Memmingen, Klinik für Urologie, Memmingen
| | - A Schneider
- Klinik und Poliklinik für Gynäkologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
| | - E Selka
- VulvaKarzinom-SHG e. V., Wilhelmshaven
| | - S Singer
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Institut für Medizinische Biometrie, Epidemiologie und Informatik, Abt. Epidemiologie und Versorgungsforschung, Mainz
| | - S Smola
- Institut für Virologie, Institut für Infektionsmedizin, Universität des Saarlandes, Homburg/Saar
| | - B Sporbeck
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Allergologie und Venerologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin
| | - M von Knebel Doeberitz
- Abteilung für Molekulare Pathologie, Pathologisches Institut des Universitätsklinikum Heidelberg, Heidelberg
| | - P Wutzler
- Universitätsklinikum Jena (Friedrich-Schiller-Universität), Institut für Virologie und Antivirale Therapie, Beutenberg Campus, Jena
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23
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Affiliation(s)
- M Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, B1050 Brussels, Belgium
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24
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Wilhelm M, Petry KU. Fetale hämolytische Anämie bei hereditärer Stomatozytose – Ein Fallbericht. Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1293458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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25
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Schopp B, Holz B, Zago M, Stubenrauch F, Petry KU, Kjaer SK, Iftner T. Evaluation of the performance of the novel PapilloCheck HPV genotyping test by comparison with two other genotyping systems and the HC2 test. J Med Virol 2010; 82:605-15. [PMID: 20166179 DOI: 10.1002/jmv.21719] [Citation(s) in RCA: 29] [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] [Indexed: 01/08/2023]
Abstract
The novel PapilloCheck genotyping test was compared with SPF10 PCR LiPav1 and PGMY09/11 on hybrid capture 2 (HC2)-pretested samples. From results of 826 cervical samples detection rates and kappa values for the tests were calculated using a HPV type consensus definition. With PapilloCheck HPV types 53, 56, and 33 were found with a sensitivity of 100%. The lowest detection rate was observed for HPV 35 (72.2%). The SPF10 PCR LiPav1 was found to be 100% positive for HPV 18, 31, 53, 56, and 35 and lowest for HPV 59 (81%). The PGMY09/11 system detected only HPV 59 at 100% detection rate and showed lowest sensitivity for HPV 56 (40.5%). Multiple infection rates ranged from 25.8% (PGMY09/11 PCR-LBA), over 39.5% (PapilloCheck) to 55.9% (SPF10 PCR LiPav1). In samples with higher viral DNA load detection rates and concordance between the genotyping tests increases. The kappa values in comparison to the HPV consensus type ranged from k = 0.21 to k = 0.82 for comparing SPF10 PCR with the HPV consensus type, while values for PGMY09/11 PCR ranged from k = 0 to k = 0.96 and were best for the PapilloCheck (k = 0.49-0.98). Detection rates for the identification of high-grade cervical intraepithelial neoplasia (CIN2+) ranged from 93.7% (PGMY09/11 PCR) to 98.4% (PapilloCheck, SPF10 PCR, HC2). In conclusion, this study shows that the PapilloCheck give comparable results to established PCR methods. However, these results also show a necessity for the standardization of genotype-specific HPV detection assays.
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Affiliation(s)
- Betti Schopp
- Sektion Experimentelle Virologie, Institute of Medical Virology, University Hospital Tuebingen, Tuebingen, Germany
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26
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Wilhelm M, Petry KU, Reinecke-Lüthge A. Intrauteriner Fruchttod bei TORCH – Fallbericht und Literaturanalyse. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Liebrich C, Brummer O, Von Wasielewski R, Wegener G, Meijer C, Iftner T, Petry KU. Primary cervical cancer truly negative for high-risk human papillomavirus is a rare but distinct entity that can affect virgins and young adolescents. EUR J GYNAECOL ONCOL 2009; 30:45-48. [PMID: 19317256] [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: 05/27/2023]
Abstract
Cancer of the uterine cervix is almost exclusively associated with human papillomavirus (HPV). Carcinogenesis is slow, the minimal time from initial HPV infection to invasive carcinoma seems to be less than ten years. In order to identify rapid onset cervical cancer, we carried out a retrospective re-analysis of an extended cohort of patients with invasive cervical cancer, and reviewed cases identified within the cancer registry of Lower Saxony or using Medline or ISI data. No instances of a rapid-onset cancer or true HPV-DNA negative cancer were found among our hospital cohort of 178 women with primary cancer of the uterine cervix. Registry data identified four out of 5,878 patients who were diagnosed with primary cervical cancer at 14 to 20 years of age. They were classified as clear-cell and endometriod adenocarcinoma and tested persistently negative for high-risk HPV-DNA. Fourteen more cases of cervical cancer in virgins and very young women were identified by a Medline search, mostly with unknown histologic type or rare subtypes of adenocarcinoma. In conclusion, rare adenocarcinoma of the uterine cervix may represent an entity unrelated to HPV, thus explaining instances of rapid onset cervical cancer.
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Affiliation(s)
- C Liebrich
- Schwerpunkt gynäkologische Onkologie, Frauenklinik, Klinikum der Stadt Wolfsburg, Wolfsburg, Germany
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28
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Dillner J, Rebolj M, Birembaut P, Petry KU, Szarewski A, Munk C, de Sanjose S, Naucler P, Lloveras B, Kjaer S, Cuzick J, van Ballegooijen M, Clavel C, Iftner T. Long term predictive values of cytology and human papillomavirus testing in cervical cancer screening: joint European cohort study. BMJ 2008; 337:a1754. [PMID: 18852164 PMCID: PMC2658827 DOI: 10.1136/bmj.a1754] [Citation(s) in RCA: 449] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To obtain large scale and generalisable data on the long term predictive value of cytology and human papillomavirus (HPV) testing for development of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+). DESIGN Multinational cohort study with joint database analysis. SETTING Seven primary HPV screening studies in six European countries. PARTICIPANTS 24,295 women attending cervical screening enrolled into HPV screening trials who had at least one cervical cytology or histopathology examination during follow-up. MAIN OUTCOME MEASURE Long term cumulative incidence of CIN3+. RESULTS The cumulative incidence rate of CIN3+ after six years was considerably lower among women negative for HPV at baseline (0.27%, 95% confidence interval 0.12% to 0.45%) than among women with negative results on cytology (0.97%, 0.53% to 1.34%)). By comparison, the cumulative incidence rate for women with negative cytology results at the most commonly recommended screening interval in Europe (three years) was 0.51% (0.23% to 0.77%). The cumulative incidence rate among women with negative cytology results who were positive for HPV increased continuously over time, reaching 10% at six years, whereas the rate among women with positive cytology results who were negative for HPV remained below 3%. CONCLUSIONS A consistently low six year cumulative incidence rate of CIN3+ among women negative for HPV suggests that cervical screening strategies in which women are screened for HPV every six years are safe and effective.
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Affiliation(s)
- Joakim Dillner
- Lund University, Medical Microbiology, University Hospital MAS, 205 02 Malmö, Sweden.
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29
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Hollwitz B, Rinnau F, Soergel P, Petry KU, Hillemanns P. HPV-assoziierte anogenitale Erkrankungen bei HIV-Infizierten im Zeitalter der HPV-Impfung – Implikationen für Prävention, Diagnose und Therapie eines multilokulären Problems. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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30
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Thiel F, Rein DT, Runnebaum IB, Petry KU, Fasching PA, Beckmann MW. AGO-Cervix-1 study: A prospective, randomized phase III study to compare the effects of Paclitaxel and Topotecan to those of Cisplatin and Topotecan for treatment of patients with recurrent or persistent cervical cancer. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1079196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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31
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Klug SJ, Molijn A, Schopp B, Holz B, Iftner A, Quint W, J.F. Snijders P, Petry KU, Kjær SK, Munk C, Iftner T. Comparison of the performance of different HPV genotyping methods for detecting genital HPV types. J Med Virol 2008; 80:1264-74. [DOI: 10.1002/jmv.21191] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Petry KU, Breugelmans JG, Bénard S, Lamure E, Littlewood KJ, Hillemanns P. Cost of screening and treatment of cervical dyskaryosis in Germany. EUR J GYNAECOL ONCOL 2008; 29:345-349. [PMID: 18714567] [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
Human papillomavirus (HPV) infection is the principal cause of cervical cancer. Clinical trials with HPV vaccines have shown high efficacy against HPV-induced precancerous cervical lesions. Before implementing a vaccination programme, up-to-date data on cervical dyskaryosis, incidence and annual treatment costs are needed. We assessed resource use and costs for 12 months following diagnosis for women with abnormal Pap smears in Germany based on a sample of 138 women who had received abnormal results on Pap smears taken during March and April of 2004. Most women had a Pap IIID (57%) vs Pap III (20%) or Pap IV (23%). Women with a Pap IV consulted their gynaecologist more frequently than those with a Pap III or Pap IIID (5.6 visits vs 4.2 and 4.6 visits, respectively). Only 9% of patients underwent colposcopy plus biopsy; this may be due to the lack of histological assessment by coloposcopy and biopsy done currently in Germany. More women in the Pap IV group had a cold knife conisation, compared with those in the Pap IIID group, (84% vs 27%) hysterectomy (22% vs 4%) and laser coagulation (12.5% vs 4%). Median treatment duration was shorter for women with a Pap III than for those with Pap IIID and IV (3 vs 5 months, respectively). Overall, 28.3% of the women were hospitalised (median 5; range 1-33 days). The estimated average annual cost per patient was Euro 1,055, Euro 943 and Euro 3,174 for Pap III, IIID and IV, respectively. The cost of managing precancerous cervical lesions in Germany was shown to be high.
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Affiliation(s)
- K U Petry
- Frauenklinik im Klinikum der Stadt Wolfsburg, Wolfsburg, Germany.
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Gross G, Ikenberg H, Petry KU, Pfister H, Schneede P, Schöfer H, Szeimies RM. [Condyloma acuminata and other HPV-associated diseases of the genitals, anus and urethra]. Hautarzt 2007; 58:179-86. [PMID: 17582847 DOI: 10.1007/s00105-006-1270-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
MESH Headings
- Anus Diseases/diagnosis
- Anus Diseases/therapy
- Anus Neoplasms/diagnosis
- Anus Neoplasms/therapy
- Carcinoma in Situ/diagnosis
- Carcinoma in Situ/therapy
- Cell Transformation, Neoplastic/pathology
- Condylomata Acuminata/diagnosis
- Condylomata Acuminata/therapy
- Diagnosis, Differential
- Female
- Genital Diseases, Female/diagnosis
- Genital Diseases, Female/therapy
- Genital Diseases, Male/diagnosis
- Genital Diseases, Male/therapy
- Genital Neoplasms, Female/diagnosis
- Genital Neoplasms, Female/therapy
- Genital Neoplasms, Male/diagnosis
- Genital Neoplasms, Male/therapy
- Germany
- Human papillomavirus 11
- Human papillomavirus 16
- Human papillomavirus 18
- Humans
- Male
- Papillomavirus Infections/diagnosis
- Papillomavirus Infections/therapy
- Recurrence
- Urethral Diseases/diagnosis
- Urethral Diseases/therapy
- Urethral Neoplasms/diagnosis
- Urethral Neoplasms/therapy
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Abstract
Human papilloma viruses (HPV) of the high-risk type cause almost all cervical carcinomas and some other anogenital tumors. Development of a carcinoma is uncommon; most infections heal spontaneously. When carcinomas develop, the latent phase is at least 8, more often 15-30 years. A negative HPV test thus excludes the risk of developing cervical carcinoma for many years. The approved vaccine against HPV 6/11/16/18 and the soon-to-be-approved one against HPV 16/18 are extremely safe and effective. Vaccinated individuals are almost 100% protected by the vaccines containing virus-like particles. Current studies suggest that 70-80% of high-grade cervical neoplasias can be avoided, as well as other vaginal, vulvar, and anal neoplasias. The yearly costs for treating precursors of these cancers exceed the cost of vaccinating all girls born in a given year. Thus HPV vaccination is cost effective, even when a modified cancer screening program is retained.
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Affiliation(s)
- K U Petry
- Frauenklinik, Klinikum der Stadt Wolfsburg, Sauerbruchstrasse 7, 38440 Wolfsburg, Deutschland.
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35
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Klug SJ, Hukelmann M, Hollwitz B, Düzenli N, Schopp B, Petry KU, Iftner T. Prevalence of human papillomavirus types in women screened by cytology in Germany. J Med Virol 2007; 79:616-25. [PMID: 17385693 DOI: 10.1002/jmv.20863] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Incidence and mortality rates of cervical cancer are higher in Germany than in other Western European countries. Type-specific human papillomavirus (HPV) distribution was investigated for the first time in Germany in an epidemiological study including 8,101 women. Women above the age of 30 years, self-referring for cervical cancer screening, were enrolled in two study centers in Hannover (Northern Germany) and Tübingen (Southern Germany). Participants were screened by the Pap smear and the hybrid capture 2 (HC2) test using the high-risk probe. All samples that were positive by the HC2 test were genotyped using the prototype PGMY09/11 PCR line blot assay. Most women in the study population had a negative Pap smear (96.7%). Prevalence of high-risk type HPV detected by HC2 was 6.4% and prevalence of carcinogenic types detected by PGMY09/11 was 4.3%. Of the PGMY09/11 PCR-positive women, 70.2% had a single infection, 28.1% had multiple infections and 1.7% remained uncharacterized. 32 different HPV types were detected using PGMY09/11 PCR. HPV 16, 31, 52, 51, 18, and 45 were the most common carcinogenic types in the study population. Among women with histologically confirmed high-grade lesions HPV 16, 45, 58, 18, 31, 33, and 52 were the predominant types. These results provide valuable information for the management of HPV infections in Germany, both in terms of future strategies of screening and vaccination.
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Affiliation(s)
- Stefanie J Klug
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Hospital of the University of Mainz, Germany
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36
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Abstract
UNLABELLED Carcinoma of the vagina is a rare entity of cancer, also a primary carcinoma of the neovagina in patients with vaginal agenesia is of rare occurrence. CASE REPORT We report on a 48-year-old female patient with a squamous cell carcinoma in neovagina after Mayer-Rokitansky-Kuester-Hauser-syndrome. Neovagina was constructed by method of Vecchietti 28 years before. Operative treatment consisted of anterior exenteration with construction of a modified Mainz-1-pouch. There were no complications intra- or postoperative. Microscopic findings showed a G2-differentiated invasive squamous cell carcinoma of the neovagina at stage FIGO III with an infiltration of urethra and the bladder neck. The tumor could be resected completely, no infestation of lymph nodes was observed. In the further process the aftercare is planned. In a systematic literature review 19 female patients with a primary carcinoma of neovagina after agenesia of vagina could be identified. CONCLUSIONS Female patients with a neovagina require a regular gynaecologic examination in order not to survey a malignant transformation although a malignoma in neovagina is rare. A possible therapy option is the radical operation, there are no data of long-term prognosis at present.
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Affiliation(s)
- C Liebrich
- Klinikum Wolfsburg, Frauenklinik, Wolfsburg.
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37
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Hollwitz BG, Rinnau F, Petry KU, Hillemanns P. Observational Management of Genital Warts in Pregnancy. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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38
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Cuzick J, Clavel C, Petry KU, Meijer CJLM, Hoyer H, Ratnam S, Szarewski A, Birembaut P, Kulasingam S, Sasieni P, Iftner T. Overview of the European and North American studies on HPV testing in primary cervical cancer screening. Int J Cancer 2006; 119:1095-101. [PMID: 16586444 DOI: 10.1002/ijc.21955] [Citation(s) in RCA: 733] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Several studies suggest that HPV testing is more sensitive than cytology in primary cervical screening. These studies had different designs and were reported in different ways. Individual patient data were collected for all European and North American studies in which cytology was routinely performed and HPV testing was included as an additional parallel test. More than 60,000 women were included. The sensitivity and specificity of HPV testing were compared with routine cytology, both overall and for ages <35, 35-49 and 50+. The age-specific prevalence of high risk HPV (hr-HPV) was also analysed. HPV testing was substantially more sensitive in detecting CIN2+ than cytology (96.1% vs. 53.0%) but less specific (90.7% vs. 96.3%). The sensitivity of HPV testing was similar in all studies carried out in different areas of Europe and North America, whereas the sensitivity of cytology was highly variable. HPV sensitivity was uniformly high at all ages, whereas the sensitivity of cytology was substantially better in women over the age of 50 than in younger women (79.3% vs. 59.6%). The specificity of both tests increased with age. Positivity rates for HPV testing in women without high-grade CIN were region dependent. These results support the use of HPV testing as the sole primary screening test, with cytology reserved for women who test HPV positive. Large demonstration projects are needed to fully evaluate this strategy.
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Affiliation(s)
- Jack Cuzick
- Cancer Research UK, Wolfson Institute of Preventive Medicine, London.
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Petry KU. [HIV and pregnancy]. MMW Fortschr Med 2005; 147 Spec No 1:63-5. [PMID: 16385880] [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
Through an optimal interdisciplinary management, it is possible to reduce the mother-to-child transmission of HIV-1 from more than 40% to less than 2%. The following are essential for this success: A risk-adapted antiviral therapy during the pregnancy and birth, a transmission prophylaxis for the new born child, delivery by Caesarean section, the early treatment of concomitant gynecological infections and abstention from breastfeeding. Unidentified HIV-positive pregnant women and inadequate support for HIV-positive pregnant women account for the majority of new HIV-1 infections in children in Germany. Hence, the HIV test should be an obligatory component of prenatal care and HIV-positive pregnant women should receive assistance at an appropriate center.
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Affiliation(s)
- K U Petry
- Chefarzt der Frauenklinik im Klinikum der Stadt Wolfsburg.
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40
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Abstract
Genital warts (GW) are the manifestation of infection with specific types of human papillomavirus (HPV), one of the most common sexually transmitted viral infections in the world. Genital warts can be either raised (exophytic) or flat. Exophytic genital warts are most commonly secondary to inoculation of the basal epithelium with nononcogenic HPV types 6 and 11, whereas flat warts are usually secondary to potentially oncogenic HPV types 16 and 31. Genital warts can occasionally cause irritation and discomfort, particularly during intercourse, although most cases are asymptomatic. It is the psychosocial effects of infection, such as a sense of shame, depression, and anxiety, that represent the more significant toll for most patients with GW. Current therapies for GW are mainly ablative and do not directly enhance the immune response to HPV. Therefore, recurrence is a problem for many patients. Imiquimod 5% cream is a patient-applied therapy that directly enhances the immune response to HPV and is safe and effective for the treatment of GW. A reduction in viral load is observed following treatment. Low recurrence rates compared to other treatment modalities may be due to the stimulation of the cell-mediated immune response by imiquimod.
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Affiliation(s)
- J Thomas Cox
- Student Health Service, University of California, Santa Barbara, California 93106, USA.
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41
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Altgassen C, Lantzsch T, Mende T, Kölbl H, Stöcklein R, Wischnik A, Abou-Dahkn M, Strecker J, Pourfard J, Meerpohl HG, Fleisch M, Dall P, Bender HG, Lampe B, Trifyllis N, Mahnert U, Hoyme UB, Tulusan AH, Bühner M, Otte C, Neis K, Böhmer G, Petry KU, Kühn T, Passeka A, Urbanzyk H, Schmatloch S, Dimpfl T, Ackermann S, Malur S, Beckmann MW, Müller B, Greinke C, Dürst M, Schneider A. HPV-Detektion in Sentinellymphknoten bei Patientinnen mit Zervixkarzinom. Geburtshilfe Frauenheilkd 2003. [DOI: 10.1055/s-2003-815255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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42
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Mittendorf T, Petry KU, Iftner T, Greiner W, von der Schulenburg JM. Economic evaluation of human papillomavirus screening in Germany. Eur J Health Econ 2003; 4:209-215. [PMID: 15609187 DOI: 10.1007/s10198-003-0187-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Cytology-based screening programs for cervical cancer have been effective in reducing cancer incidence and preventing premature deaths worldwide. However, there is concern about the relatively low sensitivity of current screening procedures. Although the causal association between infection with certain high-risk types of human papilloma virus (HPV) and the development of cervical cancer has been clearly established, testing for the major risk factor is not part of current screening practice. We created a tree decision model over time to evaluate different policy choices for implementing a population-based screening program. Results of the economic analysis indicate that testing with any implemented HPV DNA testing (stand alone or in combination with the Papanicolaou smear) is superior to cytology and measures presently in use. Additional costs per life-years gained cannot be reported because the HPV branches had fewer discounted overall costs (euro 222 million vs. euro 82 and euro 76 million, respectively), and they saved more life years (19,599 vs. 19,163 and 903, respectively) then the smear alternative. Any HPV DNA testing is preferable over the current state of the art performed in Germany. This is true not only for economic reasons but also for life-years gained. Therefore HPV DNA testing must become an essential component to back up the relatively weak sensitivity of the standard procedure.
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Affiliation(s)
- T Mittendorf
- Centre for Health Economics and Health System Research, University of Hanover, Germany.
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Petry KU, Scholz U, Hollwitz B, Von Wasielewski R, Meijer CJLM. Human papillomavirus, coinfection with Schistosoma hematobium, and cervical neoplasia in rural Tanzania. Int J Gynecol Cancer 2003; 13:505-9. [PMID: 12911728 DOI: 10.1046/j.1525-1438.2003.13301.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cervical cancer is the most common malignant tumor among women in Tanzania and other countries in tropical Africa. Genital schistosomiasis has been proposed as a possible cofactor in the genesis of this malignant disease that might contribute to its high incidence in regions where bilharzias is endemic. One hundred nine Tanzanian patients from an area with endemic bilharzias who were transferred to a gynecologic out-patient clinic were age-matched with 109 German controls. In patients and controls, separate samples were taken for cytologic assessment and human papillomavirus (HPV) DNA detection using the Hybrid Capture 2 assay (HC2) and PCR (GP5+/6 +). Samples that tested positive for HPV DNA with general primers were re-tested with HPV type-specific primers. After application of 3% acetic acid, punch biopsies were taken from any cervical lesion. Patients were interviewed for recent symptoms or clinical history suggestive of bilharzias. Urine samples from all patients were examined for the presence of schistosoma hematobium ova. Additionally six Tanzanian patients with invasive cervical cancer were included for separate analysis. Patients and controls had an identical prevalence of HPV-DNA (21.5%) using HC2. Based on PCR results with general primers, the corresponding prevalence was 34.5% for Tanzanian cases and 26.9% for German controls. A history suggestive of bilharzias and/or active schistosomiasis were associated with a significantly increased risk for infection with high-risk HPV types. We conclude that infection with Schistosoma hematobium seems to favor persistent genital HPV infection either by traumatizing the genital epithelium and/or by local immunosuppression.
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Affiliation(s)
- K U Petry
- Departments of Gynaecologic Oncology and Pathology. Medizinische Hochschule Hannover, Germany.
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Böhmer G, Petry KU, Iftner T, Brummer O, Günter HH, Flemming P, Kühnle H. [Detection of human papillomavirus DNA using hybrid capture does not allow sufficient triaging of recurrent atypical pap smear classified as Pap III D]. Zentralbl Gynakol 2002; 124:111-5. [PMID: 11935496 DOI: 10.1055/s-2002-24235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- G Böhmer
- Abteilung für gynäkologische Onkologie Frauenklinik der Medizinischen Hochschule Hannover, Germany.
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Petry KU, Böhmer G, Iftner T, Flemming P, Stoll M, Schmidt RE. Human papillomavirus testing in primary screening for cervical cancer of human immunodeficiency virus-infected women, 1990-1998. Gynecol Oncol 1999; 75:427-31. [PMID: 10600301 DOI: 10.1006/gyno.1999.5639] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Women infected with the human immunodeficiency virus (HIV) have an increased risk of cervical neoplasia while the value of cytologic screening is limited due to a high prevalence of inflammatory disease. The study was conducted to determine whether testing for human papillomavirus (HPV) DNA could improve primary screening for cervical cancer of these patients. METHODS One hundred thirty-eight HIV-infected women were examined between 1990 and 1998. Ninety-four patients with a total of 279 women-years were eligible for incidence evaluation. Colposcopy, cytology, and HPV DNA testing with the hybrid capture I assay were performed at each visit. RESULTS Seventeen cases of high-grade cervical neoplasia were diagnosed at study entry and 13 developed CIN II or CIN III during follow-up. The hybrid capture I assay detected 94.1% of prevalent and 100% of incident high-grade neoplasia, while the corresponding sensitivity of Pap smears using CIN I or worse as the referral criteria was 82.3% for prevalent and 69.2% for incident high-grade neoplasia. Eleven of 13 patients who progressed to histologically confirmed CIN II/III tested positive for HPV DNA at study entry compared with 5/13 women presenting with any degree of cytologic atypia at recruitment. The Pap smears of 36/94 women remained normal throughout the study while 54/94 patients remained negative for high-risk HPV types. CONCLUSION Hybrid capture I identified high-grade cervical neoplasia more accurately than the Pap smear and appeared to be beneficial for primary cervical cancer screening in HIV-infected women.
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Affiliation(s)
- K U Petry
- Department of Gynecological Oncology, Medizinische Hochschule Hannover, Podbielskistrasse 380, Hannover, 30659, Germany
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Oberhoff C, Neri B, Amadori D, Petry KU, Gamucci T, Rebmann U, Nowrousian MR, Voigtmann R, Monfardini S, Armand JP, Herrmann R, Netter-Pinon J, Tubiana-Mathieu N, Zwierzina H. Recombinant human erythropoietin in the treatment of chemotherapy-induced anemia and prevention of transfusion requirement associated with solid tumors: a randomized, controlled study. Ann Oncol 1998; 9:255-60. [PMID: 9602258 DOI: 10.1023/a:1008296622469] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Anemia is a common side effect of anticancer chemotherapy. Blood transfusion, previously the only available treatment for chemotherapy-induced anemia, may result in some clinical or subclinical adverse effects in the recipients. Recombinant human erythropoietin (rhEPO) provides a new treatment modality for chemotherapy-induced anemia. PATIENTS AND METHODS To evaluate the effect of rhEPO on the need for blood transfusions and on hemoglobin (Hb) concentrations, 227 patients with solid tumors and chemotherapy-induced anemia were enrolled in a randomized, controlled, clinical trial. Of 189 patients evaluable for efficacy, 101 received 5000 IU rhEPO daily s.c., while 88 patients received no treatment during the 12-week controlled phase of the study. RESULTS The results demonstrate a statistically significant reduction in the need for blood transfusions (28% vs. 42%, P = 0.028) and in the mean volume of packed red blood cells transfused (152 ml vs. 190 ml, P = 0.044) in patients treated with rhEPO compared to untreated controls. This effect was even more pronounced in patients receiving platinum-based chemotherapy (26% vs. 45%, P = 0.038). During the controlled treatment phase, the median Hb values increased in the rhEPO patients while remaining unchanged in the control group. The response was seen in all tumor types. CONCLUSIONS RhEPO administration at a dose of 5000 IU daily s.c. increases hemoglobin levels and reduces transfusion requirements in chemotherapy-induced anemia, especially during platinum-based chemotherapy.
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Affiliation(s)
- C Oberhoff
- Center for Gynecology and Obstetrics, University Hospital, Essen, Germany.
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Abstract
Inhibin, a physiological product of ovarian follicle cells, normally absent in serum of postmenopausal women, is elevated in adult granulosa cell tumours of the ovary. Recently, high serum levels of inhibin were reported in carcinomas and, surprisingly, also in Krukenberg tumours of the ovary. This study attempted to determine the site of inhibin production in primary (111 cases), metastatic (13) and secondary (10) ovarian tumours by using immunohistochemistry. Positive staining in tumour cells was encountered in all cases of sex-cord- stromal cell tumours, adult (13) and juvenile (3) granulosa cell tumours, thecofibromas (10), in a lipid cell tumour (1) and a Sertoli-Leydig cell tumour (1). Primary and secondary tumours not derived from sex-cord stroma revealed no positivity in tumour cells, but in theca-like cells in the surrounding non-neoplastic ovarian stroma. A positive reaction was not observed in non-tumour-bearing ovaries of a control group. The ovarian inhibin of postmenopausal women is derived from activated sex-cord stroma or sex-cord-stromal neoplasms. Therefore, elevated serum inhibin concentrations in women with primary or secondary ovarian neoplasms with other histogenesis seem to be due to an activation of the non-neoplastic ovarian stroma. Inhibin will fail to be a tumour marker in these cases. By contrast, it will be useful in proving sex-cord differentiation by immunohistochemistry and might be used in surveillance of malignant sex-cord derived neoplasms by serum assays.
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Affiliation(s)
- P Flemming
- Pathologisches Institut, Medizinische Hochschule Hannover, Germany
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Grassmann K, Krätzer F, Petry KU, Iftner T. Functional characterization of naturally occurring mutants of human papillomavirus type 16 with large deletions in the non-coding region. Int J Cancer 1996; 68:265-9. [PMID: 8900439 DOI: 10.1002/(sici)1097-0215(19961009)68:2<265::aid-ijc21>3.0.co;2-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Petry KU, Böhmer G, Linge G, Glaubitz M, Maschek H. [HPV-Dna hybridization allows differentiation of cervix lesions in PAP III cytologic findings]. Geburtshilfe Frauenheilkd 1996; 56:509-12. [PMID: 9036061 DOI: 10.1055/s-2007-1023274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A repeat Pap smear as well as a smear for human papillomavirus (HPV)-DNA detection with the Hybrid Capture assay (Digene diagnostics/Murex, Burgwedel) were collected from 30 women with Pap smears recurrently classified as "Pap III". All patients underwent colposcopy and histological assessment. The repeat Pap smear distinguished correctly in 15, colposcopy in 19 and the Hybrid Capture assay in 27 cases between neoplastic and inflammatory lesions. All invasive neoplasms were positive for HPV-DNA. HPV typing seems to be a suitable non-invasive method for early selection of cervical lesions that need histological assessment in women with smears classified as "Pap III".
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Affiliation(s)
- K U Petry
- Abteilung für spezielle Onkologie, Frauenklinik der Medizinischen Hochschule Hannover
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