ABSTRACT
The incidence of human papillomavirus (HPV)-related oropharyngeal cancer is increasing in some regions. Nevertheless, the epidemiology of this disease has not been extensively investigated in southern Europe. We conducted a retrospective cohort study of patients diagnosed with primary oropharyngeal cancer from 1991 to 2016. Cancer tissues underwent histopathological evaluation, DNA quality control, HPV-DNA detection and p16INK4a immunohistochemistry. Data were collected from medical records. Factors associated with HPV positivity and time trends were evaluated with multivariable Bayesian models. The adjusted prevalence of HPV-related cases in 864 patients with a valid HPV-DNA result was 9.7%, with HPV-DNA/p16INK4a double positivity being considered. HPV-related oropharyngeal cancer was likely to occur in non-smokers and non-drinkers, to be located in the tonsil or diagnosed at advanced stages. Time-trend analysis showed an increasing risk of HPV-related oropharyngeal cancer in the most recent periods (5-year period increase of 30%). This increase was highest and with a clear increasing trend only in the most recent years (2012-2016). The prevalence of HPV-related oropharyngeal cancer started to sharply increase in the most recent years in our setting, as occurred two decades ago in areas where most oropharyngeal cancer cases are currently HPV-related. Our results provide a comprehensive assessment of the epidemiological landscape of HPV-related oropharyngeal cancer in a region of southern Europe.
Subject(s)
Alphapapillomavirus , Oropharyngeal Neoplasms/epidemiology , Oropharyngeal Neoplasms/virology , Papillomavirus Infections/complications , Adult , Aged , Aged, 80 and over , Cohort Studies , Europe/epidemiology , Female , Humans , Male , Middle Aged , Papillomavirus Infections/epidemiology , Prevalence , Retrospective StudiesABSTRACT
OBJETIVOS. Determinar la concordancia en el cálculo de riesgo coronario (RC) entre la tabla de Framingham y la tabla REGICOR y las implicaciones terapéuticas al aplicar la guía de hipercolesterolemia del Institut Català de la Salut con el dintel de RC alto del 20% de Framingham (G-ICS-F), con el 20% de REGICOR (G-ICS-R20%) y con el 10% de REGICOR (G-ICS-R10%). MÉTODO. Estudio descriptivo transversal en un Área Básica Urbana. Participan 413 pacientes hipercolesterolémicos sin cardiopatía isquémica. Se analizaron edad, sexo, antecedentes familiares de cardiopatía isquémica, tabaquismo, hipertensión arterial (HTA), presión arterial sistólica (PAS) y perfil lipídico completo previo al tratamiento. Se calculó el RC usando las tablas de Framingham y de REGICOR y se analizaron las indicaciones terapéuticas. RESULTADOS. La concordancia entre el RC calculado con Framingham y REGICOR es muy débil (kappa = 0,066). Aplicando la G-ICS-F tratamos farmacológicamente al 22,8%, con la G-ICSR20% al 10,4% y con la G-ICS-R10% al 20,8%. La concordancia de la intervención terapéutica entre G-ICS-F y G-ICS-R20% es moderada (kappa = 0,535), siendo buena entre G-ICS-F y G-ICS-R10% (kappa = 0,688). Presentan discordancia dos grupos: el 4,3% sin tratamiento según G-ICS-F y con tratamiento G-ICS-R10% y el 6,3% con tratamiento según G-ICS-F y sin tratamiento G-ICS-R10%. CONCLUSIONES. El cálculo del RC con REGICOR puede infraestimar el riesgo de nuestra población y con Framingham sobreestimarlo. Nos parece un opción razonable aceptar como alto el RC > 10% con REGICOR en nuestra guía terapéutica para estimar el riesgo de forma correcta, reduciendo ligeramente el número de tratamientos a aplicar, con el consiguiente impacto fármaco-económico
OBJECTIVES. To determine concordance in the coronary risk (CR) score between Framingham and REGICOR charts and the therapeutic consequences in following the hyperlipidemia guideline of Institut Català de la Salut for high-level coronary risk with 20% Framingham function (G-ICS-F), 20% REGICOR function (G-ICS-R 20%) or 10% REGICOR function (G-ICS-R-10%). METHOD. Descriptive cross-sectional study in a Primary Health Care Center. Four hundred and thirteen patients with hypercholesterolemia and no history of ischemic heart disease were enrolled. Age, gender, family history of coronary disease, smoking habits, hypertension, systolic blood pressure and complete lipid profile before treatment were studied. Coronary risk was estimated by means of Framingham and REGICOR functions. Theoretical indications of lipid-lowering treatment were analyzed. RESULTS. There is strong disagreement between coronary risk calculated with Framingham and REGICOR charts (kappa coefficient 0.066). Lipid-lowering treatment is indicated in 22.8% patients with G-ICS-F-10,4% with G-ICS-R-20% and 20.8% with G-ICSR-10%. The agreement of recommended treatment between G-ICS-F and G-ICS-R-20% is moderate (kappa 0.535), while between G-ICS-F and G-ICS-R-10% is good (kappa 0.688). There is no agreement in two groups: 4.3% without treatment by G-ICS-F and treated by G-ICS-R-10% and the 6.3% treated by G-ICS-F and without treatment by G-ICS-R-10% CONCLUSIONS. The estimation of coronary risk may be either overestimates (Framingham) or underestimates (REGICOR) in our patients. We conclude that a reasonable option may be to accept G-ICS-R-10% in our therapy guideline to properly estimate the coronary risk. Furthermore, it will reduce the number of patients under treatment with the consequent drug-financial impact
