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Syrjänen K, Shabalova I, Sarian L, Naud P, Longatto-Filho A, Derchain S, Kozachenko V, Zakharchenko S, Roteli-Martins C, Nerovjna R, Kljukina L, Tatti S, Branovskaja M, Branca M, Grunjberga V, Erzen M, Juschenko A, Serpa Hammes L, Podistov J, Costa S, Syrjänen S. Covariates of high-risk human papillomavirus (HPV) infections are distinct for incident CIN1, CIN2 and CIN3 as disclosed by competing-risks regression models. EUR J GYNAECOL ONCOL 2012; 33:5-14. [PMID: 22439398] [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: 05/31/2023]
Abstract
BACKGROUND In addition to the oncogenic human papillomavirus (HPV), several cofactors are needed in cervical carcinogenesis, but whether the HPV covariates associated with incident (i) CIN1 are different from those of incident (ii) CIN2 and (iii) CIN3 needs further assessment. OBJECTIVES To gain further insights into the true biological differences between CIN1, CIN2 and CIN3, we assessed HPV covariates associated with incident CIN1, CIN2, and CIN3. STUDY DESIGN AND METHODS HPV covariates associated with progression to CIN1, CIN2 and CIN3 were analysed in the combined cohort of the NIS (n = 3187) and LAMS study (n = 12,114), using competing-risks regression models (in panel data) for baseline HR-HPV-positive women (n = 1105), who represent a sub-cohort of all 1865 women prospectively followed-up in these two studies. RESULTS Altogether, 90 (4.8%), 39 (2.1%) and 14 (1.4%) cases progressed to CIN1, CIN2, and CIN3, respectively. Among these baseline HR-HPV-positive women, the risk profiles of incident CIN1, CIN2 and CIN3 were unique in that completely different HPV covariates were associated with progression to CIN1, CIN2 and CIN3, irrespective which categories (non-progression, CIN1, CIN2, CIN3 or all) were used as competing-risks events in univariate and multivariate models. CONCLUSIONS These data confirm our previous analysis based on multinomial regression models implicating that distinct covariates of HR-HPV are associated with progression to CIN1, CIN2 and CIN3. This emphasises true biological differences between the three grades of CIN, which revisits the concept of combining CIN2 with CIN3 or with CIN1 in histological classification or used as a common endpoint, e.g., in HPV vaccine trials.
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Affiliation(s)
- K Syrjänen
- Department of Oncology & Radiotherapy, Turku University Hospital, Turku, Finland.
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2
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Syrjänen K, Shabalova I, Sarian L, Naud P, Longatto-Filho A, Derchain S, Kozachenko V, Zakharchenko S, Roteli-Martins C, Nerovjna R, Kljukina L, Tatti S, Branovskaja M, Branca M, Grunjberga V, Erzen M, Juschenko A, Hammes LS, Podistov J, Costa S, Syrjänen S. Longitudinal outcomes of high-risk human papillomavirus (HPV) infections as competing-risks events following cervical HPV test at baseline visit in the NIS-LAMS cohort. EUR J GYNAECOL ONCOL 2012; 33:341-352. [PMID: 23091888] [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: 06/01/2023]
Abstract
BACKGROUND The complex natural history of human papillomavirus (HPV) infections following a single HPV test can be modeled as competing-risks events (i.e., no-, transient- or persistent infection) in a longitudinal setting. The covariates associated with these competing events have not been previously assessed using competing-risks regression models. OBJECTIVES To gain further insights in the outcomes of cervical HPV infections, we used univariate- and multivariate competing-risks regression models to assess the covariates associated with these competing events. STUDY DESIGN AND METHODS Covariates associated with three competing outcomes (no-, transient- or persistent HR-HPV infection) were analysed in a sub-cohort of 1,865 women prospectively followed-up in the NIS (n = 3,187) and LAMS Study (n = 12,114). RESULTS In multivariate competing-risks models (with two other outcomes as competing events), permanently HR-HPV negative outcome was significantly predicted only by the clearance ofASCUS+ Pap during FU, while three independent covariates predicted transient HR-HPV infections: i) number of recent (< 12 months) sexual partners (risk increased), ii) previous Pap screening history (protective), and history of previous CIN (increased risk). The two most powerful predictors of persistent HR-HPV infections were persistent ASCUS+ Pap (risk increased), and previous Pap screening history (protective). In pair-wise comparisons, number of recent sexual partners and previous CIN history increase the probability of transient HR-HPV infection against the HR-HPV negative competing event, while previous Pap screening history is protective. Persistent ASCUS+ Pap during FU and no previous Pap screening history are significantly associated with the persistent HR-HPV outcome (compared both with i) always negative, and ii) transient events), whereas multiparity is protective. CONCLUSIONS Different covariates are associated with the three main outcomes of cervical HPV infections. The most significant covariates of each competing events are probably distinct enough to enable constructing of a risk-profile for each main outcome.
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Affiliation(s)
- K Syrjänen
- Department of Oncology & Radiotherapy, Turku University Hospital, Turku, Finland.
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3
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Syrjänen K, Shabalova I, Naud P, Derchain S, Sarian L, Kozachenko V, Zakharchenko S, Roteli-Martins C, Nerovjna R, Longatto-Filho A, Kljukina L, Tatti S, Branovskaja M, Branca M, Grunjberga V, Erzen M, Juschenko A, Hammes LS, Costa S, Podistov J, Syrjänen S. Co-factors of high-risk human papillomavirus infections display unique profiles in incident CIN1, CIN2 and CIN3. Int J STD AIDS 2011; 22:263-72. [PMID: 21571974 DOI: 10.1258/ijsa.2009.009280] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In addition to oncogenic 'high-risk' human papillomaviruses (HR-HPV), several co-factors are needed in cervical carcinogenesis, but it is poorly understood whether these HPV co-factors associated with incident cervical intraepithelial neoplasia (CIN) grade 1 are different from those required for progression to CIN2 and CIN3. To gain further insights into the true biological differences between CIN1, CIN2 and CIN3, we assessed HPV co-factors increasing the risk of incident CIN1, CIN2 and CIN3. Data from the New Independent States of the Former Soviet Union (NIS) Cohort (n = 3187) and the Latin American Screening (LAMS) Study (n = 12,114) were combined, and co-factors associated with progression to CIN1, CIN2 and CIN3 were analysed using multinomial logistic regression models with all covariates recorded at baseline. HR-HPV-positive women (n = 1105) represented a subcohort of all 1865 women prospectively followed up in both studies. Altogether, 90 (4.8%), 39 (2.1%) and 14 (1.4%) cases progressed to CIN1, CIN2 and CIN3, respectively. Baseline HR-HPV was the single most powerful predictor of incident CIN1, CIN2 and CIN3. When controlled for residual HPV confounding by analysing HR-HPV-positive women only, the risk profiles of incident CIN1, CIN2 and CIN3 were unique. Completely different HPV co-factors were associated with progression to CIN1, CIN2 and CIN3 in univariate and multivariate analyses, irrespective of whether non-progression, CIN1 or CIN2 was used as the reference outcome. HPV co-factors associated with progression to CIN1, CIN2 and CIN3 display unique profiles, implicating genuine biological differences between the three CIN grades, which prompts us to re-visit the concept of combining CIN2 with CIN3 or CIN1.
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Affiliation(s)
- K Syrjänen
- Department of Oncology and Radiotherapy, Turku University Hospital, Savitehtaankatu 1, 20521 Turku, Finland.
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4
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Syrjänen K, Shabalova I, Naud P, Kozachenko V, Derchain S, Zakharchenko S, Roteli-Martins C, Nerovjna R, Longatto-Filho A, Kljukina L, Tatti S, Branovskaja M, Hammes LS, Branca M, Grunjberga V, Eržen M, Juschenko A, Costa S, Sarian L, Podistov J, Syrjäen S, Syrjänen K, Syrjänen S, Shabalova I, Petrovichev N, Kozachenko V, Zakharova T, Pajanidi J, Podistov J, Chemeris G, Sozaeva L, Lipova E, Tsidaeva I, Ivanchenko O, Pshepurko A, Zakharenko S, Nerovjna R, Kljukina L, Erokhina O, Branovskaja M, Nikitina M, Grunjberga V, Grunjberg A, Juschenko A, Santopietro R, Cintorino M, Tosi P, Syrjänen K, Naud P, Derchain S, Roteli-Martins C, Longatto-Filho A, Tatti S, Branca M, Eržen M, Hammes LS, Matos J, Gontijo R, Sarian L, Braganća J, Arlindo FC, Maeda MYS, Lörincz A, Dores GB, Costa S, Syrjänen S. Risk estimates for persistent high-risk human papillomavirus infections as surrogate endpoints of progressive cervical disease critically depend on reference category: analysis of the combined prospective cohort of the New Independent States of the Former Soviet Union and Latin American Screening Studies. Int J STD AIDS 2011; 22:315-23. [DOI: 10.1258/ijsa.2009.009365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Summary To make feasible future clinical trials with new-generation human papillomavirus (HPV) vaccines, novel virological surrogate endpoints of progressive disease have been proposed, including high-risk HPV (HR-HPV) persistence for six months (6M+) or 12 months (12M+). The risk estimates (relative risks [RRs]) of these ‘virological endpoints’ are influenced by several variables, not yet validated adequately. We compared the impact of three referent groups: (i) HPV-negative, (ii) HPV-transient, (iii) HPV-mixed outcome on the risk estimates for 6M+ or 12M+ HR-HPV persistence as predictors of progressive disease. Generalized estimating equation models were used to estimate the strength of 6M+ and 12M+ HR-HPV persistence with disease progression to squamous intraepithelial lesions (SILs), cervical intraepithelial neoplasia (CIN) grade 1 +, CIN2+, CIN/SIL endpoints, comparing three optional reference categories (i)-(iii) in a prospective sub-cohort of 1865 women from the combined New Independent States of the Former Soviet Union (NIS) and Latin American Screening (LAMS) studies cohort ( n = 15,301). The RRs of these viral endpoints as predictors of progressive disease are affected by the length of viral persistence (6M+ or 12M+) and the surrogate endpoint (SIL, CIN1, CIN2, CIN/SIL). Most dramatic is the effect of the referent group used in risk estimates, with the HPV-negative referent group giving the highest and most consistent RRs for both 6M+ and 12M+ viral persistence, irrespective of which surrogate is used. In addition to deciding on whether to use 6M+ or 12M+ persistence criteria, and cytological, histological or combined surrogate endpoints, one should adopt the HPV-negative referent group as the gold standard in all future studies using viral persistence as the surrogate endpoint of progressive disease.
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Affiliation(s)
- K Syrjänen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - I Shabalova
- Russian Academy of Post-Graduate Medical Education. Moscow, Russia
| | - P Naud
- Hospital de Clinicas de Porto Alegre, and Department of Gynecology and Obstetrics, Federal University of Rio Grande do Sul. Porto Alegre
| | - V Kozachenko
- Russian Academy of Post-Graduate Medical Education. Moscow, Russia
| | - S Derchain
- Universidade Estadual de Campinas, Campinas, Brazil
| | - S Zakharchenko
- Novgorod Municipal Dermato-venereological Dispensary, Department of Gynaecology, Novgorod, Russia
| | | | - R Nerovjna
- Novgorod Female Consultative Outpatient Hospital. Department of Gynaecology, Novgorod, Russia
| | - A Longatto-Filho
- lnstituto Adolfo Lutz, Sao Paulo, Brazil and Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - L Kljukina
- Research Institute of Oncology and Medical Radiology, Republican Centre of Clinical Cytology, Minsk, Belarus
| | - S Tatti
- First Chair Gynecology Hospital de Clinicas, Buenos Aires, Argentina
| | - M Branovskaja
- Minsk State Medical Institute. Department of Gynaecology and Obstetrics, Minsk, Belarus
| | - L S Hammes
- Hospital de Clinicas de Porto Alegre, and Department of Gynecology and Obstetrics, Federal University of Rio Grande do Sul. Porto Alegre
| | - M Branca
- Unit of Cytopathology, National Centre of Epidemiology, Surveillance and Promotion of Health, National Institute of Health (ISS), Rome, Italy
| | - V Grunjberga
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - M Eržen
- SIZE Diagnostic Center, Ljubljana, Slovenia
| | - A Juschenko
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - S Costa
- Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - L Sarian
- Universidade Estadual de Campinas, Campinas, Brazil
| | - J Podistov
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - S Syrjäen
- Department of Oral Pathology, Institute of Dentistry, University of Turku, Turku, Finland
| | - K Syrjänen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - S Syrjänen
- Department of Oral Pathology, Institute of Dentistry, and MediCity Research Laboratory, University of Turku, Finland
| | - I Shabalova
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
- Russian Academy of Post-Graduate Medical Education, Moscow, Russia
| | - N Petrovichev
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - V Kozachenko
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - T Zakharova
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - J Pajanidi
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - J Podistov
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - G Chemeris
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - L Sozaeva
- Russian Academy of Post-Graduate Medical Education, Moscow, Russia
| | - E Lipova
- Russian Academy of Post-Graduate Medical Education, Moscow, Russia
| | - I Tsidaeva
- Russian Academy of Post-Graduate Medical Education, Moscow, Russia
| | - O Ivanchenko
- Novgorod Clinical Regional Hospital, Centralised Cytology Laboratory, Novgorod, Russia
| | - A Pshepurko
- Novgorod Clinical Regional Hospital, Centralised Cytology Laboratory, Novgorod, Russia
| | - S Zakharenko
- Novgorod Municipal Dermato-venereological Dispensary, Department of Gynaecology, Novgorod, Russia
| | - R Nerovjna
- Novgorod Female Consultative Outpatient Hospital, Department of Gynaecology, Novgorod, Russia
| | - L Kljukina
- Research Institute of Oncology and Medical Radiology, Republican Centre of Clinical Cytology, Minsk, Belarus
| | - O Erokhina
- Research Institute of Oncology and Medical Radiology, Republican Centre of Clinical Cytology, Minsk, Belarus
| | - M Branovskaja
- Minsk State Medical Institute, Department of Gynaecology and Obstetrics, Minsk, Belarus
| | - M Nikitina
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - V Grunjberga
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - A Grunjberg
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - A Juschenko
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - R Santopietro
- Department of Human Pathology and Oncology, University of Siena, Italy
| | - M Cintorino
- Department of Human Pathology and Oncology, University of Siena, Italy
| | - P Tosi
- Department of Human Pathology and Oncology, University of Siena, Italy
| | - K Syrjänen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - P Naud
- Hospital de Clinicas de Porto Alegre, Brazil
| | - S Derchain
- Universidade Estadual de Campinas, Campinas, Brazil
| | | | - A Longatto-Filho
- Instituto Adolfo Lutz, Sao Paulo, Brazil and (ALF) Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - S Tatti
- First Chair Gynecology Hospital de Clinicas, Buenos Aires, Argentina
| | - M Branca
- Unit of Cytopathology, National Centre of Epidemiology, Surveillance and Promotion of Health, National Institute of Health (ISS), Rome, Italy
| | - M Eržen
- SIZE Diagnostic Center, Ljubljana, Slovenia
| | - LS Hammes
- Hospital de Clinicas de Porto Alegre, Brazil
| | - J Matos
- Hospital de Clinicas de Porto Alegre, Brazil
| | - R Gontijo
- Universidade Estadual de Campinas, Campinas, Brazil
| | - L Sarian
- Universidade Estadual de Campinas, Campinas, Brazil
| | - J Braganća
- Universidade Estadual de Campinas, Campinas, Brazil
| | - FC Arlindo
- Hospital Leonor M de Barros, Sao Paulo, Brazil
| | - MYS Maeda
- Instituto Adolfo Lutz, Sao Paulo, Brazil and (ALF) Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | | | - GB Dores
- Di gene Brazil, Sao Paulo, Brazil
| | - S Costa
- Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - S Syrjänen
- Department of Oral Pathology, Institute of Dentistry, University of Turku, Finland
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5
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Syrjänen S, Naud P, Sarian L, Derchain S, Roteli-Martins C, Longatto-Filho A, Tatti S, Branca M, Erzen M, Hammes LS, Costa S, Syrjänen K. Immunosuppressive cytokine Interleukin-10 (IL-10) is up-regulated in high-grade CIN but not associated with high-risk human papillomavirus (HPV) at baseline, outcomes of HR-HPV infections or incident CIN in the LAMS cohort. Virchows Arch 2009; 455:505-15. [PMID: 19908064 DOI: 10.1007/s00428-009-0850-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 10/08/2009] [Accepted: 10/13/2009] [Indexed: 11/30/2022]
Abstract
Bypassing the local immunological defense reactions in the cervix is one of the prerequisites for human papillomaviruses (HPV) infections to progress to intraepithelial neoplasia (CIN). The role of potent immunosuppressive cytokines, e.g., interleukin-10 (IL-10), depressing these local virus-specific immunological responses is incompletely studied. To assess, whether IL-10 expression in cervical HPV lesions has any implications in the outcome of HPV infections or disease progression to CIN. Baseline cervical biopsies from 225 women of the LAMS study sub-cohort were analyzed for IL-10 expression using immunohistochemistry, to assess its associations with CIN grade, and high-risk HPV (HR-HPV) at baseline, as well as in predicting outcomes of HR-HPV infections, and development of incident CIN1+ and CIN2+ in this longitudinal setting. Expression of IL-10 in cervical lesions was up-regulated most often in high-grade CIN, and IL-10 over-expression retained its value as independent predictor of CIN2+ (odds ratio (OR) = 4.92) and CIN3+ (OR = 7.51) also in multivariate model, including HR-HPV and several known covariates of IL-10 expression. Up-regulation was not related to HR-HPV detection, and showed no relationship to HR-HPV viral loads. Using longitudinal predictive indicators (SE, SP, PPV, NPV), IL-10 expression was of no value in predicting (1) the outcomes of HR-HPV infections, or (2) the surrogate endpoints (incident CIN1+, CIN2+) of progressive disease. IL-10 over-expression (along with HR-HPV) was one of the independent covariates of CIN2/3. This immunosuppressive cytokine might play an important role in creating a microenvironment that favors progressive cervical disease and immune evasion by HR-HPV.
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Affiliation(s)
- Stina Syrjänen
- Department of Oral Pathology, Institute of Dentistry, University of Turku, Turku, Finland
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6
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Syrjänen K, Naud P, Derchain S, Roteli-Martins C, Longatto-Filho A, Tatti S, Branca M, Eržen M, Hammes LS, Matos J, Gontijo R, Sarian L, Bragança J, Arlindo FC, Maeda MYS, Lörincz A, Dores GB, Costa S, Syrjänen S. Drug addiction is not an independent risk factor for oncogenic human papillomavirus infections or high-grade cervical intraepithelial neoplasia: case-control study nested within the Latin American Screening study cohort. Int J STD AIDS 2008; 19:251-8. [DOI: 10.1258/ijsa.2007.007179] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Drug abuse (addiction) has been listed among the risk factors for human papillomavirus (HPV) infections, but no case-control studies exist to rule out sexual behaviour and other potential confounders. The aim of this study is to evaluate the role of drug addiction as an independent predictor of HR-HPV infections and (cervical intraepithelial neoplasia) CIN2+ in an age-matched case-control (1:4) study nested within the prospective Latin American Screening (LAMS) study cohort. All 109 women in the LAMS cohort (n = 12,114) reporting drug abuse/addiction were matched with four controls (n = 436) of non-abusers strictly by age. Conditional logistic regression analysis was used to estimate the co-variates of drug abuse, and the whole series (n = 545) was analysed for predictors of HR-HPV and CIN2+ using univariate and multivariate regression models. Oncogenic HPV infections were significantly (P = 0.019) more prevalent among abusers (37.7%) than in controls (21.9%), but there was no difference in high-grade squamous intraepithelial lesions (P = 0.180) or CIN2+ lesions (P = 0.201). In multivariate conditional logistic regression, number of lifetime sexual partners (P = 0.0001), ever smokers (P = 0.0001), non-use of OCs (P = 0.013), ever having sexually transmitted diseases (STD) (P = 0.041) and no previous Pap smear (P = 0.027) were independent co-variates of drug addiction. Drug abuse was not an independent risk factor of high-risk (HR)-HPV infection, which was significantly predicted by (1) age below 30 years (P = 0.045), (2) more than five lifetime sexual partners (P = 0.046) and (3) being current smoker (P = 0.0001). In multivariate model, only HR-HPV infection was an independent risk factor of CIN2+ (P = 0.031), with adjusted OR = 11.33 (95% CI 1.25–102.50). These data indicate that drug addiction is not an independent risk factor of either HR-HPV infections or CIN2+, but the increased prevalence of HR-HPV infections is explained by the high-risk sexual behaviour and smoking habits of these women.
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Affiliation(s)
- K Syrjänen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - P Naud
- Hospital de Clinicas de Porto Alegre
| | - S Derchain
- Universidade Estadual de Campinas, Campinas
| | | | - A Longatto-Filho
- Instituto Adolfo Lutz, Sao Paulo, Brazil
- University of Minho, Braga, Portugal
| | - S Tatti
- First Chair Gynecology Hospital de Clinicas, Buenos Aires, Argentina
| | - M Branca
- Unit of Cytopathology, National Centre of Epidemiology, Surveillance and Promotion of Health, National Institute of Health (ISS), Rome, Italy
| | - M Eržen
- SIZE Diagnostic Center, Ljubljana, Slovenia
| | | | - J Matos
- Hospital de Clinicas de Porto Alegre
| | - R Gontijo
- Universidade Estadual de Campinas, Campinas
| | - L Sarian
- Universidade Estadual de Campinas, Campinas
| | - J Bragança
- Universidade Estadual de Campinas, Campinas
| | | | - M Y S Maeda
- Instituto Adolfo Lutz, Sao Paulo, Brazil
- University of Minho, Braga, Portugal
| | | | | | - S Costa
- Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - S Syrjänen
- Department of Oral Pathology, Institute of Dentistry, University of Turku, Finland
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8
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Syrjänen K, Naud P, Derchain S, Roteli-Martins C, Longatto-Filho A, Tatti S, Branca M, Erzen M, Hammes LS, Matos J, Gontijo R, Sarian L, Braganca J, Arlindo FC, Maeda MYS, Lörincz A, Dores GB, Costa S, Syrjänen S. Comparing PAP smear cytology, aided visual inspection, screening colposcopy, cervicography and HPV testing as optional screening tools in Latin America. Study design and baseline data of the LAMS study. Anticancer Res 2005; 25:3469-80. [PMID: 16101165] [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: 05/04/2023]
Abstract
OBJECTIVES This is a European Commission (EC)-funded ongoing study known as the LAMS (Latin American Screening) study, where PAP smear/liquid-based cytology and screening colposcopy were compared with i) three optional screening tools [visual inspection with acetic acid (VIA), or Lugol's iodine (VILI), cervicography] and with ii) Hybrid Capture II from a) conventional samples and from b) self-samples, in women at different risk for cervical cancer in Brazil and Argentina. STUDY DESIGN During 2002-2003, a cohort of 12,107 women attending four clinics: Campinas (CA), Sao Paulo (SP), Porto Alegre (PA) and Buenos Aires (BA), were interviewed for risk factors, and examined using the 8 diagnostic arms. Colposcopy was performed for women positive in any test and for 5% of women with baseline PAP-negative and 20% of HCII-negatives. All high-grade lesions (CIN2/3) were treated, and low-grade CIN are prospectively followed-up. RESULTS Of the 12,107 women, the following baseline data are available: epidemiological data (n=11,996), conventional PAP smears (n=10,363), LBC, SurePATH (n=320), LBC, DNA-Citoliq (n=1,346), VIA (n=12.067), VILI (n=3,061), cervicography (n=279), screening colposcopy (n=3,437), HCII conventional (n=4,710), HCII self-sampling (n=246) and cervical biopsies (n=1,524). The four sub-cohorts differ significantly in all their baseline data on the implicated risk factors of cervical cancer, consonant with their origin from regions with different cancer incidence. Around 95% of all PAP smears were negative, with slight variations in the prevalence of LSIL and HSIL between the four centers. Significant differences were found in the detection rates of abnormal findings in VIA, VILI and colposcopy between the four centers (p=0.0001). The prevalence of HPV was practically identical (16.5-18.8%) in all four cohorts (p=0.486), with no differences in the relative viral loads. Biopsy results were different depending on whether the women underwent screening colposcopy (BA) or elective colposcopy (others). CONCLUSION Four cohorts with significantly different baseline data are available, and prospective follow-up of these women permits analysis of whether variations in cervical cancer incidence in these regions is due to i) different natural history of the precursor lesions, or ii) due to different levels of exposure to the known risk factors.
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Affiliation(s)
- K Syrjänen
- Department of Oncology and Radiotherapy, Turku University Central Hospital, Turku, Finland.
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