Presença do DNA plasmático dos Papillomavirus Humanos16 e 18 como marcador de recidiva/persistência do câncer de colo do útero

Abstract

Cervical cancer (CC) is considered a global public health problem and originates from persistent infection with oncogenic Human Papillomavirus (HPV), mainly genotypes 16 and 18. Follow-up of patients after treatment of CC, can lead to a better prognosis and increase the survival of these women through monitoring early detection of relapse/persistence, which can be done by detecting circulating HPV DNA in patients' plasma, and the presence of HPV genetic material. virus is associated with the tendency to develop relapse/persistence. Objective: To analyze the presence of circulating HPV DNA in plasma as a predictive marker of disease relapse/persistence in monitoring cervical cancer treatment. Objective: This study aimed to analyze the presence of circulating HPV DNA in plasma as a predictive marker for disease recurrence/persistence in the monitoring of cervical cancer treatment. Methods: This was a prospective cohort study involving Amazonian women undergoing treatment at the Fundação Centro de Controle de Oncologia, in which samples were collected at four stages: phase zero (before the start of treatment), phase 1 (around six months after starting treatment), phase 2 (about nine months after starting treatment) and phase 3 (about 18 months after starting treatment). The women were divided into Group A (FIGO IA to IIB) and Group B (FIGO IIIA to IVA). To detect HPV, the samples were subjected to a real-time PCR (qPCR) assay targeting the E7 gene of HPV 16 and 18. Results: 39 patients diagnosed with cervical cancer between August 31, 2020 and September 30, 2022 were included in the study, 13 from Group A and 26 from Group B. Age ranged between 25 and 80 years, with mean age 48.4 ±SD 13.4; Eighteen women (46.1%) reported being illiterate or having incomplete primary education; 30 (77.0%) had no income or had an income of up to one minimum wage; 31 (79.5%) had their first sexual intercourse between 12 and 17 years old; 17 (43.6%) were hyper-screened according to Brazilian guidelines (more than one cytology every three years); one (16.7%) had HIV infection; 59,1% reported not taking the CC screening exam due to inhibition, shame, fear or lack of time; 35 (89.7%) had a histopathological diagnosis of squamous cell carcinoma, four (10.3%) of adenocarcinoma; 26 (66.7%) presented stage III-IV. The most frequent therapeutic choice was chemotherapy (CT) and radiotherapy (RT) (74.4%); 12 (30.8%) women presented relapse/persistence after treatment; four (10.3%) died; 21 (53.8%) were positive before treatment for HPV 16 in plasma and none for HPV 18; group B had a higher frequency of detectable circulating HPV DNA (81.0%) (p = 0.041); one patient was positive for HPV16 in phases zero, 1 and 2 so that in phase 1 there was a decrease in the number of circulating HPV16 DNA copies, a fact that coincided with the end of radiotherapy; in a patient who had relapse/persistence of the disease, it was possible to detect circulating HPV DNA in plasma six months before the clinical diagnosis of relapse/persistence. The date of the first consultation and the start of treatment varied between one and 29 months, with an average value of 6 ± 5 months. Conclusions: Detection of cf-DNA HPV is a clinically useful marker in post-treatment surveillance of cervical cancer. Cf- HPV DNA could be detected 6 months before disease relapse/persistence.