Case Control Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2015; 21(8): 2352-2357
Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2352
Detection of human papillomavirus DNA in esophageal carcinoma in Greece
Georgios Georgantis, Theodoros Syrakos, Theodoros Agorastos, Spiridon Miliaras, Asterios Gagalis, Georgios Tsoulfas, Konstantinos Spanos, Georgios Marakis
Georgios Georgantis, Theodoros Syrakos, Spiridon Miliaras, Georgios Tsoulfas, Konstantinos Spanos, Georgios Marakis, 1st Surgical Clinic of the Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
Theodoros Agorastos, 4th Department of Gynecology and Obstetrics of the Aristotle University of Thessaloniki, Ippokrateio Hospital, 54642 Thessaloniki, Greece
Asterios Gagalis, Department of Endoscopy, Papageorgiou Hospital, 56403 Thessaloniki, Greece
Author contributions: Georgantis G, Syrakos T, Agorastos T and Miliaras S designed the research; Georgantis G and Gagalis A performed the research; Tsoulfas G and Georgantis G wrote the paper; Spanos K analyzed the data; and Marakis G reviewed the manuscript and made a substantial contribution to the final version.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Georgios Georgantis, General Surgeon Scientific Collaborator, 1st Surgical Clinic of the Aristotle University of Thessaloniki, Papageorgiou General Hospital, D Gounari 8, 56403 Thessaloniki, Greece. geogeorgantis@gmail.com
Telephone: +30-231-3323684 Fax: +30-231-0991581
Received: August 8, 2014
Peer-review started: August 9, 2014
First decision: August 27, 2014
Revised: September 15, 2014
Accepted: November 19, 2014
Article in press: November 19, 2014
Published online: February 28, 2015
Processing time: 203 Days and 19.6 Hours
Abstract

AIM: To detect human papillomavirus (HPV) in the esophageal mucosa and the possible relationship with esophageal cancer in Greece.

METHODS: Forty-nine patients underwent esophagogastroduodenoscopy (EGD) and esophageal biopsy at a university hospital that acts as a referral center for Northern Greece. Nineteen of these patients (14 male and 5 female) had esophageal squamous cell carcinoma (ESCC) and 30 (15 male and 15 female) did not have any reported esophageal malignancy. Histopathological assessment was followed by polymerase chain reaction analysis of all the samples. Patient demographic data (age, sex, and place of birth) and information regarding smoking habits, alcohol consumption or sexual habits were collected. A method of statistical interference, verification of hypotheses based on homogeneity and independent χ2 test, was used.

RESULTS: From the 49 patients that underwent EGD and biopsy, 19 had ESCC and 30 had normal esophageal mucosa, with a mean age of 65.2 years. Regarding the prevalence of oncogenic risk factors for esophageal carcinoma, an interesting conclusion was that 78% of the patients used tobacco and almost one-third had multiple sexual partners, whereas only 20% of the patients consumed alcohol, which was not statistically significant, when compared to the control group. In the ESCC group, the only two positive samples were among the male patients (2/14 male patients with ESCC, 14.5%). No HPV was identified in the control group. The predominant HPV types identified were 11 and 31, which have a low malignancy potential. The presence of HPV DNA in the ESCC group was not statistically significant, 95% confidence interval (χ2 = 3.292, P = 0.07).

CONCLUSION: This is the first relevant study in Greece, and despite the lack of statistical significance, the issue of HPV infection and ESCC does merit further investigation.

Keywords: Esophageal cancer; Esophageal squamous cell carcinoma; Human papilloma virus; Polymerase chain reaction

Core tip: A similarity between the esophagus and cervix is the presence of squamous cells at the gastroesophageal junction. This has led to the hypothesis that at the lower esophagus there may be a transformation zone where insults, such as human papillomavirus (HPV) infection, can have a carcinogenic effect (similar to HPV in cervical cancer). The relationship between esophageal carcinoma and HPV was investigated by polymerase chain reaction analysis of esophageal biopsies in a case-control study. Although there was a non-significant correlation between esophageal squamous cell carcinoma and HPV, the issue merits further attention.