[Prevalence of human papillomavirus infections in our five-year data]. / Humán papillomavírus-infekció prevalenciája közel ötéves anyagunkban.

Human papillomavirus infection proved to be the most important risk factor for the development of cervical cancer and its preblastomatosis. Human papillomavirus was detected from 1996. June to 2000. September at 1635 patients, who had been positive by colposcopy and/or cytology in an earlier examination. The place of the study were our outpatients' departments and consultations by specialists of Debrecen University, Department of Obstetrics and Gynecology. Hybrid capture system was used to demonstrate the presence of the virus and managed to prove it in the 28.9% of cases. 3.1% of the patients (51 persons) had acquired low-risk, and 23.6% (386 persons) high risk virus types, however 2.1% of the woman (35 patients) were infected with both low-risk and high-risk human papillomavirus types at the same time. Long time decrease of virus prevalence was observed after the age of 35 year, and the significant degree and timing decrease of after the age of 30 year at patients infected with combination of low-risk and high-risk virus types, respectively. This observation is indicative of the correlation between colposcopic-, cytologic abnormalities and the persisting high-risk human papillomavirus infections.

Integration status of virus DNA and p53 codon 72 polymorphism in human papillomavirus type 16 positive cervical cancers.

BACKGROUND: The aim of this study was to determine the physical state of HPV16 DNA and to reveal any association between the physical state of virus DNA and pathologic or prognostic factors in HPV16 positive cervical cancers. The other aim was to estimate the role of p53 codon 72 polymorphism in disease progression. MATERIALS AND METHODS: The presence and physical state of HPV16 DNA was analysed by Southern blot hybridisation and E1-E2 specific PCRs in the primary tumours and pelvic lymph nodes of 85 cervical carcinoma patients. Results Integrated HPV16 DNA was found in 32 out of 41 (78%) primary tumours and 2 out of 22 (95%) lymph nodes carrying HPV16 DNA. No significant association was found between integration of virus DNA and course of the disease. There was a trend towards an association between disease recurrence and the presence of the p53 codon 72 arginine homozygous genotype (OR = 3.41, p = 0.23). CONCLUSION: The physical state of HPV16 DNA does not seem to play a major role as a prognostic indicator in Hungarian cervical cancer patients, while the p53 codon 72 genotype may have an impact on the clinical outcome of the disease.

Poor clinical outcome in early stage cervical cancer with human papillomavirus-18 positive lymph nodes.

Epidemiologic and molecular studies have proven that human papillomavirus (HPV) plays an important role in the development of cervical cancer. However, the role of the virus in the progression of the disease, i.e. in the development of lymph node metastasis and in the adverse clinical outcome is poorly understood. We have been using the polymerase chain reaction (PCR) to study the presence and typing of human papillomavirus DNA since 1980 in cervical cancers and pelvic lymph nodes from the same patients. Out of the series of 47 cervical cancer patients we focused on four women (age: 41, 33, 35 and 56 years) in this article. The follow-up of these patients revealed early recurrences of the disease (7, 7, 17, 22 months) with very short survival (9, 10, 21, 24 months). Although we detected HPV-18 positivity both in the cervical tumors and in the regional lymph nodes too in all four cases, lymph nodes were negative by routine hystology in case of the three young patients (21, 33, 35 years of age). Our observations suggest that HPV type 18 positive cervical cancer patients, despite negative histological findings in the lymph nodes should be consider as a subpopulation for poor outcome especially in the young age group (p=0,022, Fisher's exact test).

Additional human papillomavirus types detected by the hybrid capture tube test among samples from women with cytological and colposcopical atypia.

The type specificity of the human papillomavirus (HPV) Hybrid Capture Tube (HCT) test was evaluated by using typing with PCR (MY09-MY11)-restriction fragment length polymorphism (RFLP) and sequencing. All samples HCT test positive for only low-risk HPV (n = 15) or only high-risk HPV (n = 102) were confirmed, whereas 9 of 12 HCT test double-positive samples contained only high-risk HPV types as determined by PCR-RFLP. Several high-risk HPV types (HPV-53, -58, -62, -66, -CP8304, and -MM4) not included in the HCT test were indeed detected, indicating a broader detection range with retained distinction between low-risk and high-risk HPV types.

[Follow-up of high risk, human papillomavirus (HPV)-positive patients with cancer of the uterine cervix]. / Magas kockázatú humán papillomavírus (HPV)-pozitív, méhnyakrákos betegek kórlefolyásának követése.

The study population consisted of 30 cervical cancer patients stage I.a-II.b. (FIGO) stages operated on according to the Wertheim technique. A parallel histological evaluation and HPV status determination were carried out on biopsies from the primary tumors and on the regional lymph nodes. A general primer mediated polymerase chain reaction (PCR) was performed at first and the samples not amplified were examined by type-specific primers. All except one primary tumors contained DNA-sequences characteristic for high risk HPV-types. The lymph nodes of these HPV-positive patients proved to be also HPV-positive with a frequency of 25/30 (83%). The frequency of the HPV-positivity was higher (100%) in the group of patients with HPV-18 positive status, than in the HPV-16 positive group. Two thirds of the evaluated regional lymph nodes were HPV-positive in the HPV-16 group of patients. The same HPV-types were harboured by the primary tumors and by the regional lymph nodes both in the HPV-16 positive and HPV-18 positive groups of patients. In the HPV-16-positive group of patients metastatic lymph nodes occurred with a frequency of 3/16, while the frequency of HPV-16 positivity in the same nodes was 11/15. In the group of patients with HPV-18 positivity the difference was even greater, 1/12 v. 12/12. Early recurrences were detected in a relation of 3 to 1 in the group of patients with histologically tumor-free and metastatic-positive lymph node status. At the same time all of the lymph nodes in this group with early recurrency (4/4) contained DNA-sequences characteristic for the HPV-18 type. These findings raise the hypothesis that the HPV-specific nucleic acids detected in the lymph nodes can be taken as sensitive indicators of metastases. The follow-up results support these hypothesis as patients with HPV-18 positive lymph node status showed early recurrencies and short survival that is poor prognosis not corresponding to the early stage of cervical cancer with histologically negative lymph node status.

Second-look surgery (SLO) in the management of carcinoma of the ovary.

There is a permanent controversy on the clinical relevance of second-look laparotomies. In the first approach the majority of clinical experts evaluated this procedure experimental. Our results support the idea of clinical relevance of this procedure as patients with SLOs through the early detection of recurrence really profited from the procedure.

The prognostic value of CA-125 in epithelial ovarian cancer patients during and after chemotherapy.

In the past ten years the investigations on CA-125 levels of epithelial ovarian cancer patients have raised several questions both in the screening and in the follow-up. The predictive value of the test during the postoperative chemotherapy and the follow-up period was the topic in the series of examinations. Our findings are as follows. The decrease of the CA-125 level predicts a long tumour free survival. The permanent high level of CA-125 is a signal of a recurrence within few month after stopping therapy. In case of increase of the CA-125 level an early recurrence can be expected.

The role of high risk HPV lymph node positivity in the surgical staging of cancer of the uterine cervix.

The presence of oncogenic Human Papillomavirus (HPV) DNAs in cervical carcinomas and their normal and metastatic pelvic lymph nodes is studied worldwide. Does the HPV positivity without histological metastasis in the lymph nodes mean an early prognostic indicator in the progress of the disease? The authors analyzed the surgical, histological and virological data of four cervical cancer patients, whose recurrence occurred very early and died soon. After performing radical hysterectomy with precise removal of the pelvic lymph nodes, they assessed the operative specimens by routine histology and detected for HPV types by PCR. All the four lymph nodes harboured HPV-18 subtype in spite of negative histology in three cases. Thus the authors consider that if the lymph nodes contain any type of high-risk HPVs maybe despite negative histology or early stage of cancer we have to treat the patient as if she had an advanced cervical cancer.