Different Association of Human Papillomavirus 16 Variants with Early and Late Presentation of Cervical Cancer

• Published in: PloS one Vol. 11; no. 12; p. e0169315
• Main Authors: Alfaro, Ana, Juárez-Torres, Eligia, Medina-Martínez, Ingrid, Mateos-Guerrero, Norma, Bautista-Huerta, Maura, Román-Bassaure, Edgar, Villegas-Sepúlveda, Nicolás, Berumen, Jaime
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 30.12.2016; Public Library of Science (PLoS)
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - pathology; Adenocarcinoma - virology; Adult; Age; Age Factors; Aged; Aged, 80 and over; Base Sequence; Biology and life sciences; Cancer; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - virology; Case studies; Cervical cancer; Cervical Intraepithelial Neoplasia - diagnosis; Cervical Intraepithelial Neoplasia - pathology; Cervical Intraepithelial Neoplasia - virology; Cervix; Deoxyribonucleic acid; DNA; DNA sequencing; DNA, Viral - genetics; Female; Gene sequencing; Genetic Variation; Health risk assessment; Human papillomavirus; Human papillomavirus 16 - classification; Human papillomavirus 16 - genetics; Human papillomavirus 16 - isolation & purification; Humans; Infections; Medicine and Health Sciences; Menopause; Mexico - epidemiology; Middle Aged; Papillomaviridae; Papillomavirus; Papillomavirus Infections - epidemiology; Papillomavirus Infections - virology; Patients; People and Places; Regression analysis; Regression models; Research and Analysis Methods; Risk; Risk Factors; Sequence Analysis, DNA; Squamous cell carcinoma; Systematic review; Trends; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - virology; Virology; Young Adult; Mexico; Argentina
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0169315

The median age of cervical cancer (CC) presentation coincides with the mean age of menopause presentation (49 years) in Mexico. Here, we investigated the association between different HPV16 variants and early (≤ 49 years) or delayed (≥ 50 years) CC presentation. We conducted a case-case study that included 462 CCs, 386 squamous cell carcinomas (SCC), 63 adenocarcinomas (ACC), and 13 additional cell types. Variants were identified by PCR and DNA sequencing. The risk conferred by each variant for developing CC earlier than 50 years was analyzed using a univariate logistic regression model considering old-aged patients (≥ 50 years) and non-HPV16 cases as the reference variables. Overall, the frequency of HPV16 was 50.9%, and the only identified variants were the European A1/2 (31.2%) and the Asian-American D2 (10.8%), and D3 (8.9%). D2 was mainly associated with ≤ 49-year-old patients (15.9%); A1/2 was uniformly distributed between the two age groups (~31%), whereas D3 increased with age to a frequency of 11.8% in the older group. Only the D2 variant conferred a 3.3-fold increase in the risk of developing CC before 50 years of age (OR = 3.3, 95% CI = 1.7-6.6, p < 0.001) in relation with non-HPV16 cases. Remarkably, this risk was higher for ACC (OR = 6.0, 95% CI = 1.1-33, p < 0.05) than for SCC (OR = 2.8, 95% CI = 1.3-5.9, p < 0.01). Interestingly, when analyzing only the HPV16-positive CC, D2 increases (OR = 2.5, 95% CI = 1.2-5, p < 0.05) and D3 decreases (OR = 0.45, 95% CI 0.2-0.9, p < 0.05) the risk to develop CC before 50 years old in relation with A1/2 variant. These results indicated that D2 variant is associated with early and D3 with delayed CC presentation, whereas A1/2 variant was uniformly distributed between the two age groups.