Caracterização Molecular da infecção pelo papilomavírus humano em lesões de colo de útero de mulheres submetidas ao tratamento cirúrgico no serviço de alta complexidade do Estado do Amazonas

Abstract

Cervical cancer presents alarming rates in the northern region of Brazil, and in Amazonas this incidence is 53/100,000 women. The persistence and presence of high-risk human papillomavirus (HPV) is related to the development of this neoplasia. About 70% of cervical cancer cases involves HPV 16 and 18 genotypes, being the most frequent in all geographic regions and studies in Brazil shows a genotypic variability. The objective of this study was to characterize the most prevalent HPV genotypes in women with cervical cancer and cervical intraepithelial neoplasia grade III (CIN III), attended at referral center in the state of Amazonas. This is an observational, cross-sectional, descriptive study carried out at the Fundação Centro de Controle de Oncologia do Amazonas - FCECON (Oncology Control Center of Amazonas), in women undergoing total hysterectomy, diagnosed with CIN III and invasive cervical cancer. For HPV detection, Real-Time PCR methods for HPV 16 and 18, generic PCR (PGMY09 / 11) and PapilloCheck® commercial kit. From 42 women included in the study, 30.9% were diagnosed with CIN III and 69.1% with invasive carcinoma, with HPV frequency of 86,2%. The most frequent genotypes were HPV 16 (70.3%), followed by HPV 18 (21.6%). HPV 06 was found in a patient who had co-infection with HIV and EBV, presenting a diagnosis of CIN III. There was statistical significance regarding the age of women and the presence of HPV (p = 0.020). FIGO staging the patients presented a more frequent stage in 1BI (23.8%). Three patients presented staging IIB, IIIB and IVB. The most frequent histological type in patients with invasive carcinomas was squamous cell carcinomas (52.4%), followed by ADC with 14.3% and one case of adenosquamous The mean age distribution in relation to HPV genotypes and patient pathological status showed that women with HPV 16 and 18 genotypes were older (p = 0.350), as were women with invasive carcinoma (p = 0.096). HPV 06 found in one of the patients is a low-risk genotype and has been reported to be involved in the pathogenesis of high-grade lesions and is associated with other viruses. Clinical stage is a prognostic factor for the treatment of the disease, but other studies, such as survival analyses are necessary. The prevalence of the adenocarcinoma was high in this population and its association with HPV genotypes with a higher oncogenicity, can make it more aggressive as seen in other studies. Because HPV 16 is the most prevalent genotype in high grade lesions or cervical cancer it is necessary to carry out new studies on the mutations in HPV 16 DNA to understand its pathogenicity in the different histological types.