Cai Tommaso, Di Vico Tommaso, Durante Jacopo, Tognarelli Alessio, Bartoletti Riccardo
Unit of Urology, Santa Chiara Hospital, Trento, Italy.
Unit of Urology, University of Pisa, Pisa, Italy.
Minerva Urol Nefrol. 2018 Dec;70(6):579-587. doi: 10.23736/S0393-2249.18.03141-7. Epub 2018 Aug 29.
Human papilloma virus (HPV) is the most common sexually transmitted pathogen and its potential role in the genesis of several diseases such as cervical, head and neck, anal and penile cancers, is now largely recognized. Aim of this review article was to evaluate and summarize the state of the art of HPV-related urogenital cancers, focusing on the potentially innovative methods for the diagnosis of infection that should be used to improve viral causative detection and prevent its diffusion through sexual intercourses.
The initial search was carried out by using the Medline and the Google Scholar computerized databases through the selected key-words to identify the more recent literature on HPV epidemiology and its relationship with the main relevant urinary tract cancers. Studies were selected, extracted, analyzed and summarized. The PRISMA statement criteria were adopted and reported.
Polymerase chain reaction assay (HPV test) represents the best option for the diagnosis of HPV infection. Difficulties for the diagnosis in male are due to the site of investigation (glans, sub coronal sulcus, scrotum, urine, sperm) and the method adopted to take the sample (brushing, tissue biopsy). Due to these reasons several studies analyzed seemed to be incomparable. HPV infection is generally found in about 20% of heterosexual men. Its connection with cervical, anal, head and neck and penile cancer has been previously evidenced in 90%, 60%, 68% and 40% of cases respectively. In particular, HPV infection differed significantly among penile squamous cell carcinoma (SCC) subtypes ranging from 22.4% in verrucous subtype to 66.3% for the basaloid/warty subtype. Although the connection between prostate cancer and HPV infection has never been previously confirmed, forest plot analysis relative to a series of nine studies done during the last ten years, demonstrated a 7.7 objective risk (OR) for subjects with HPV infection to develop subsequent prostate cancer. On the other hand, some authors found comparable results in subjects with prostate cancer, benign prostate hyperplasia and prostate inflammation, thus demonstrating that this link still remains questionable. Similarly, the connection between HPV infection and urothelial, testicular and renal cancer continue to be hotly debated although HPV has been found in the urine, semen and renal tissue of patients respectively.
Integrated parts of HPV (E6 and E7 fractions) have been previously found in cervical, head and neck, anal and penile cancers. Conversely, although the evidence of concomitant HPV infection, integrated viral genome in cancer cells DNA had never been demonstrated in all the other genito-urinary tract cancers, and its role in the tumor genesis remain still largely debated. This is the reason why HPV infection should be tested in all patients with genitourinary cancer to better investigate about its potential role in the tumor genesis and development. Moreover, HPV infection option should be kept in mind when considering possible viral transmission to sexual partners.
人乳头瘤病毒（HPV）是最常见的性传播病原体，其在宫颈癌、头颈癌、肛门癌和阴茎癌等多种疾病发生过程中的潜在作用目前已得到广泛认可。这篇综述文章的目的是评估和总结HPV相关泌尿生殖系统癌症的最新进展，重点关注用于诊断感染的潜在创新方法，这些方法应有助于提高病毒病因检测并防止其通过性行为传播。
最初通过使用Medline和谷歌学术计算机数据库，通过选定的关键词进行检索，以识别关于HPV流行病学及其与主要相关泌尿系统癌症关系的最新文献。对研究进行筛选、提取、分析和总结。采用并报告了PRISMA声明标准。
聚合酶链反应检测（HPV检测）是诊断HPV感染的最佳选择。男性诊断的困难在于检查部位（龟头、冠状沟下、阴囊、尿液、精液）以及采样方法（刷取、组织活检）。由于这些原因，所分析的几项研究似乎缺乏可比性。HPV感染在约20%的异性恋男性中普遍存在。此前已分别在90%、60%、68%和40%的病例中证实其与宫颈癌、肛门癌、头颈癌和阴茎癌有关。特别是，HPV感染在阴茎鳞状细胞癌（SCC）亚型中差异显著，从疣状亚型的22.4%到基底样/疣状亚型的66.3%不等。尽管此前从未证实前列腺癌与HPV感染之间的联系，但对过去十年进行的九项研究的森林图分析显示，HPV感染患者患后续前列腺癌的客观风险为7.7（比值比）。另一方面，一些作者在前列腺癌、良性前列腺增生和前列腺炎症患者中发现了类似结果，因此表明这种联系仍存在疑问。同样，尽管分别在患者的尿液、精液和肾组织中发现了HPV，但HPV感染与尿路上皮癌、睾丸癌和肾癌之间的联系仍存在激烈争论。
此前已在宫颈癌、头颈癌、肛门癌和阴茎癌中发现HPV的整合部分（E6和E7片段）。相反，尽管有HPV合并感染的证据，但癌细胞DNA中的整合病毒基因组从未在所有其他泌尿生殖系统癌症中得到证实，其在肿瘤发生中的作用仍存在很大争议。这就是为什么应对所有泌尿生殖系统癌症患者进行HPV感染检测，以更好地研究其在肿瘤发生和发展中的潜在作用。此外，在考虑可能将病毒传播给性伴侣时，应考虑HPV感染的情况。
