RESUMO
OBJECTIVES: A study was conducted to determine the prevalence of HPV infection in cervical lesions of Brazilian women and to search for specific risk factors associated to progression to malignancy. METHODS: Five hundred and fourteen paraffin-embedded biopsies obtained from female cervical lesions were classified according to the Bethesda System in low grade squamous intraepithelial lesion (LSIL), high grade SIL (HSIL) and squamous cell carcinoma (SCC). Specimens were tested for the presence of human papillomavirus (HPV) types 6/11,16/18 and 31/33/35 DNA using non-isotopic in situ hybridization. RESULTS: HPV prevalence ranged from 85.6% in LSIL to 55.2% in SCC. Patients were analysed through an 8 year period: 27. 1% of the lesions spontaneously regressed while 43.6% persisted and 29.3% progressed to carcinoma. High risk types were present in 80.5% (Crude OR 13.8, P=0.0003) of the progressive lesions. Possible co-factors have also been evaluated: history of other sexually transmitted diseases, mainly syphilis, showed to be positively related to progression (Adjusted OR 13.0, P=0.0003) while oral contraceptive use and tobacco smoking were not significantly related to it (P>O.1). Association of two or more co-factors also proved to be related to progression. CONCLUSIONS: Oncogenic HPV types 16 and 18 and history of other concurrent sexually transmitted diseases were found to be significantly associated with progression to cancer. Smoking and the use of oral contraceptives did not show a relation to cancer establishment, but when they were associated a significant co-operative role in progression was demonstrated. Our study indicated that HPV and other risk factors for cancer can act together, corroborating the observation of a poor prognosis for Brazilian women presenting SILs.
Assuntos
Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Infecções Tumorais por Vírus/epidemiologia , Displasia do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Feminino , Humanos , Hibridização In Situ , Pessoa de Meia-Idade , Papillomaviridae/genética , Infecções por Papillomavirus/virologia , Prevalência , Fatores de Risco , Infecções Tumorais por Vírus/virologia , Neoplasias do Colo do Útero/virologia , Displasia do Colo do Útero/virologiaRESUMO
Two hundred and thirty paraffin-embedded biopsies obtained from female cervical lesions were tested for the presence of human papillomavirus (HPV) types 6/11, 16/18 and 31/33/35 DNA using non-isotopic in situ hybridization. Specimens were classified according to the Bethesda System in low grade squamous intraepithelial lesion (LSIL), high grade SIL (HSIL) and squamous cell carcinoma (SCC). HPV prevalence ranged from 92.5% in LSIL to 68.5% in SCC. Benign types were prevalent in LSILs while oncogenic types infected predominantly HSILs and SCC. HPV infection showed to be age-dependent, but no significant relation to race has been detected. Patients were analyzed through a five-year period: 20.7% of the lesions spontaneously regressed while 48.9% persisted and 30.4% progressed to carcinoma. Patients submitted to treatment showed a 19.4% recurrence rate. High risk types were present in 78.6% (CrudeOR 13.8, P = 0.0003) of the progressive lesions, and in 73.7% of the recurrent SILs (COR 19.3, P = 0.0000001). Possible co-factors have also been evaluated: history of other sexually transmitted diseases showed to be positively related either to progression (Adjusted OR 13.0, P = 0.0002) or to recurrence (AOR 17.2, P = 0.0002) while oral contraceptive use and tobacco smoking were not significantly related to them (P > 0.1). Association of two or more co-factors also proved to be related to both progression and recurrence, indicating that they may interact with HPV infection in order to increase the risk of developing malignant lesions.
PIP: 230 paraffin-embedded biopsies obtained from female cervical lesions were tested for the presence of human papillomavirus (HPV) type 6/11, 16/18, and 31/33/35 DNA using non-isotopic in situ hybridization. Specimens were classified according to the Bethesda System as low grade squamous intraepithelial lesion (LSIL), high grade SIL (HSIL), and squamous cell carcinoma (SCC). HPV prevalence ranged from 92.5% in LSIL to 68.5% in SCC. Benign types were prevalent in LSILs, while oncogenic types infected predominantly HSILs and SCC. HPV infection was found to be age-dependent, but no significant relation to race has been detected. Patients were analyzed through a 5-year period: 20.7% of the lesions spontaneously regressed, while 48.9% persisted and 30.4% progressed to carcinoma. Patients submitted to treatment showed a 19.4% recurrence rate. High risk types were present in 78.6% (crude OR (COR), 13.8; P = 0.0003) of the progressive lesions, and in 73.7% of the recurrent SILs (COR, 19.3; P = 0.0000001). Possible cofactors have also been evaluated: history of other sexually transmitted diseases was found to be positively related either to progression (adjusted OR (AOR), 13.0; P = 0.0002) or to recurrence (AOR, 17.2; P = 0.0002), while oral contraceptive use and tobacco smoking were not significantly related to them (P 0.1). Association of two or more cofactors also proved to be related to both progression and recurrence, indicating that they may interact with HPV infection in order to increase the risk of developing malignant lesions.