Evaluation of Persistent Infection by Oncogenic Human Papillomavirus (HPV) in Patients Treated for Cervical Carcinoma and Its Relation to Prognostic Factors
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 100
研究概览
简要总结
Cervical cancer is strongly associated with HPV infection, yet current post-treatment follow-up relies on cytology and imaging, which have limited accuracy, particularly after radiotherapy. Emerging evidence suggests that HPV clearance is linked to better outcomes and that HPV testing may outperform cytology in detecting recurrence.
This study aims to evaluate a panel of prognostic biomarkers to identify patients at higher risk of recurrence. These include cervical and circulating HPV-DNA (presence, genotype, and load), vaginal microbiota, host DNA methylation, SOD2 expression, and immune profile.
By enabling earlier and more accurate detection of recurrence, these biomarkers may improve patient outcomes, reduce reliance on costly imaging, and support earlier discharge for low-risk patients.
详细描述
The association between HPV infection and cervical carcinoma is established in medicine. Tests that assess the presence of HPV in the cervix are already used in primary screening and post-treatment follow-up of cervical precursor lesions (CINs), allowing earlier discharge from tertiary centers, reducing costs and the number of outpatients returns.
Post-treatment follow-up of cervical carcinoma is performed with cervical-vaginal cytology and imaging tests. However, there are already studies demonstrating that both the sensitivity and specificity of cytology are low, leading to false-positive diagnoses or late diagnoses of recurrences, since the treatment with radiotherapy, the treatment of choice for locally advanced cervical carcinoma, can lead to cytological alterations not always related to carcinogenesis.
For cervical carcinoma, there are few studies on the role of the persistence of viral infection in the therapeutic response and recurrence of the disease, most of which are retrospective and with few patients. Despite this, the results show that viral clearance is associated with better outcomes. In addition, when studying the comparison between HPV testing and cervical-vaginal cytology in predicting recurrences at 3 years, HPV testing was shown to be superior in both sensitivity and specificity. Since cervical carcinoma is the third most common in Brazilian women and currently follow-up is conducted with low-accuracy tests, it is of paramount importance that new methodologies be studied, aiming at more accurate and earlier diagnoses of recurrences.
In this context, this project aims to evaluate different prognostic biomarkers that could indicate the group of patients at higher risk of recurrence.
The biomarkers analyzed will be presence, genotyping and load of cervical HPV-DNA, presence of circulating HPV-DNA, vaginal microbiota profile, host DNA methylation, SOD2 expression in tumor tissue and the patient's immunological profile.
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •Diagnosis of HPV-associated squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma
- •Treatment-naïve
- •FIGO 2018 stage IB3 to IVA
- •Candidates for curative-intent pelvic radiotherapy with concurrent chemoradiation
排除标准
- •Tumors with rare histology, such as small cell tumors, sarcomas, and lymphomas
- •FIGO 2018 stages IA, IB1, IB2, and IVB
- •Planned initial treatment is surgical or palliative
- •Uncertain primary tumor site (cervix vs. endometrium)
- •Pregnant or in the postpartum period
- •Immunosuppression (e.g., HIV infection with active disease, autoimmune diseases, transplant recipients)