Human papillomavirus type distribution in 30,848 invasive ... - Zervita

4 HPV type distribution in cervical cancerEpidemiologyTable 2. Selected human papillomavirus (HPV) types in invasive cervical cancer (ICC), overall and by histological typeHistological typeOverallSCC 2ADCSCC vs. ADCHPV type 1 Alpha-species N % 95% CI N % 95% CI N % 95% CI p value 3Any 30,357 89.9 88.2, 91.3 26,667 90.9 89.3, 92.3 3,525 82.0 78.4, 85.1

Li et al. 5EpidemiologyFigure 1. The ten most frequently detected human papillomavirus (HPV) types in invasive cervical cancer (ICC) 1990–2010, by region.Abbreviation: N: number of cases tested for the given HPV type.ICC across the Asian continent, which is estimated to bearmore than half of the world’s cervical cancer burden. 6The most common types in ICC after HPV16 and HPV18were confirmed to be consistent in all world regions and overtime, namely a combination of HPV31, 33, 35, 45, 52 and 58,with few exceptions. Our present findings are in agreementwith those from our previous meta-analysis, 3 as well as withthose from the uniformly tested samples of the IARCInt. J. Cancer: 000, 000–000 (2010) VC 2010 UICC

6 HPV type distribution in cervical cancerEpidemiologyTable 3. Selected human papillomavirus (HPV) types in invasive cervical cancer (ICC) and adeno/adenosquamous carcinoma (ADC), by yearof publication1990–1999 2000–2005 2006–2010HPV type N % 95% CI N % 95% CI N % 95% CI p for trend 1All ICCAny 7,523 85.9 82.5, 88.8 7,877 87.9 85.7, 89.8 14,957 92.9 90.8, 94.5 0.001Single 5,963 82.1 78.1, 85.5 5,621 80.4 77.3, 83.2 12,350 76.8 73.0, 80.2 0.010Multiple 5,963 4.0 3.0, 5.4 5,621 9.0 5.9, 13.5 12,350 15.7 12.8, 19.2

Li et al. 7Table 4. Human papillomavirus (HPV) 16 prevalence in invasive cervical cancer by year of publication, across strata of region, specimen typeand PCR primer1990–1999 2000–2005 2006–2010N % HPV16-positive N % HPV16-positive N % HPV16-positive p for trend7,662 7,871 15,210RegionAfrica 457 47.5 880 57.8 674 47.6 0.779Eastern Asia 2,357 45.7 3,283 51.7 6,011 59.3 0.009Western/Central Asia 153 64.7 373 60.6 1,525 68.5 0.215Europe 2,688 56.7 1,647 61.0 4,575 60.5 0.351North America 670 51.0 637 57.3 1,178 54.8 0.160South/Central America 1,064 51.4 890 46.3 1,056 64.7 0.026Oceania 273 59.3 161 54.0 191 52.9 0.069Specimen typeFresh/fixed biopsies 6,339 53.3 5,665 57.5 12,427 60.6 0.013Exfoliated cervical cells 1,323 44.7 2,206 47.4 2,783 57.1 0.012PCR primerGP5þ/6þ 1,155 51.2 1,925 55.1 3,026 62.2 0.036MY09/11 3,749 51.8 1,705 53.8 1,863 65.9

8 HPV type distribution in cervical cancerTable 5. Prevalence of all, single and multiple infections by year of publication, for any human papillomavirus (HPV) type, HPV16 andHPV18 1 Overall 1990–1999 2000–2005 2006–2010N % N % N % N %All ICC 12,106 1,673 2,938 7,495Any HPV-positive All 11,307 93.4 1,529 91.4 2,733 93.0 7,045 94.0Single 9,766 80.7 1,479 88.4 2,470 84.1 5,817 77.6Multiple 1,541 12.7 50 3.0 263 9.0 1,228 16.4HPV16-positive All 6,929 57.2 864 51.6 1,635 55.7 4,430 59.1Single 5,984 49.4 831 49.7 1,481 50.4 3,672 49.0Multiple 945 7.8 33 2.0 154 5.2 758 10.1HPV18-positive All 2,077 17.2 272 16.3 587 20.0 1,218 16.3Single 1,466 12.1 245 14.6 445 15.1 776 10.4Multiple 611 5.0 27 1.6 142 4.8 442 5.9ADC only 1,156 152 405 599Any HPV-positive All 1,036 89.6 129 84.9 360 88.9 547 91.3Single 917 79.3 129 84.9 330 81.5 458 76.5Multiple 119 10.3 0 0.0 30 7.4 89 14.9HPV16-positive All 462 40.0 42 27.6 172 42.5 248 41.4Single 395 34.2 42 27.6 150 37.0 203 33.9Multiple 61 5.3 0 0.0 22 5.4 39 6.5HPV18-positive All 467 40.4 70 46.1 155 38.3 242 40.4Single 374 32.4 70 46.1 104 25.7 200 33.4Multiple 89 7.7 0 0.0 51 12.6 38 6.3p for trend(single vs. multiple)

Li et al. 9the newer estimation of the fraction of ICC attributable tothe combination of these types (101.0%) is certainly inflatedby the multiple counting of HPV types in multipleinfections.In conclusion, the rise of the fraction of multiple infectionsin ICC, which is understood to arise from a single cell,poses serious interpretation problems. Unless functionalinvolvement of HPV types in multiple infections is demonstrated,the attribution of the various HPV types present inmultiple infections remains uncertain. However, demonstratingwhich HPV type is functionally relevant to a tumour, byusing techniques such as microdissection and/or detection ofE6 or E7 transcripts, remains difficult. 16 It is thereforeincreasingly challenging to distinguish between clinically relevantand irrelevant HPV infections and thereby to estimatethe benefits of tests and vaccines including more or lessbroad ranges of HPV types. 17AcknowledgementsDuring this work, Dr. Ni Li was the recipient of an IARC postdoctoral fellowship,and Dr. Rebecca Howell-Jones was the recipient of a postdoctoralfellowship at IARC financed by the ‘‘Fondation Innovations en Infectiologie(FINOVI).’’References1. IARC. Monographs on the evaluation ofcarcinogenic risks to humans, vol. 100: Areview of carcinogens, Part B: biologicalagents. Lyon: International Agency forResearch on Cancer, in press.2. Clifford GM, Smith JS, Plummer M,Muñoz N, Franceschi S. Humanpapillomavirus types in invasive cervicalcancer worldwide: a meta-analysis. 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