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TP53 codon 72 polymorphism and cervical cancer: a pooled analysis of individual data from 49 studies - 11/08/11

Doi : 10.1016/S1470-2045(09)70187-1 
Stefanie J Klug, DrPhD a, , Meike Ressing, MD a, Jochem Koenig, PhD a, Martin C Abba, PhD b, Theodoros Agorastos, ProfMD c, Sylvia MF Brenna, PhD d, Marco Ciotti, MD e, BR Das, PhD f, Annarosa Del Mistro, MD g, Aleksandra Dybikowska, PhD h, Anna R Giuliano, ProfPhD i, Zivile Gudleviciene, MD j, Ulf Gyllensten, ProfPhD k, Andrea LF Haws, MD l, Aslaug Helland, MD m, C Simon Herrington, ProfMD n, Alan Hildesheim, PhD o, Olivier Humbey, PhD p, Sun H Jee, ProfPhD q, Jae Weon Kim, ProfMD r, Margaret M Madeleine, PhD s, Joseph Menczer, ProfMD t, Hextan YS Ngan, ProfMD u, Akira Nishikawa, MD v, Yoshimitsu Niwa, MD w, Rosemary Pegoraro, PhD x, MR Pillai, ProfPhD y, Gulielmina Ranzani, ProfPhD z, Giovanni Rezza, MD aa, Adam N Rosenthal, MD ab, Susanta Roychoudhury, PhD ac, Dhananjaya Saranath, PhD ad, Virginia M Schmitt, ProfPhD ae, Sharmila Sengupta, ProfPhD af, Wannapa Settheetham-Ishida, PhD ag, Hiroshi Shirasawa, ProfPhD ah, Peter JF Snijders, ProfPhD ai, Mark H Stoler, ProfMD aj, Angel E Suárez-Rincón, MD ak, Krisztina Szarka, PhD al, Ruth Tachezy, PhD am, Masatsugu Ueda, MD an, Ate GJ van der Zee, ProfMD ao, Magnus von Knebel Doeberitz, ProfMD ap, Ming-Tsang Wu, ProfMD aq, Tsuyoshi Yamashita, MD ar, Ingeborg Zehbe, PhD as, Maria Blettner, ProfPhD a
a Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg-University of Mainz, Mainz, Germany 
b CINIBA, Faculty of Medical Sciences, National University of La Plata, La Plata, Argentina 
c 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece 
d Medical School, City Sao Paolo University–UNICID and Leonor Mendes de Barros Maternity Hospital, Sao Paolo, Brazil 
e Laboratory of Molecular Virology, University Hospital Tor Vergata, Rome, Italy 
f Super Religare Laboratories Limited, Mumbai, India 
g Istituto Oncologico Veneto-IRCCS, Padova, Italy 
h Department of Hematology and Transplantalogy, Medical University of Gdansk, Gdansk, Poland 
i Department of Cancer Epidemiology and Genetics, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA 
j Department of Cancerogenesis and Tumor Pathophysiology, Institute of Oncology, Vilnius University, Vilnius, Lithuania 
k Department of Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden 
l Baylor College of Medicine, Houston, TX, USA 
m Department of Genetics/Oncology, The Norwegian Radium Hospital, Oslo, Norway 
n Bute Medical School, University of St Andrews, St Andrews, Fife, UK 
o Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA 
p EA 3181-IBCT–IFR 133 Université de Franche-Comté, Besançon Cedex, France 
q Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea 
r Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University, Seoul, South Korea 
s Cancer Epidemiology Collaborative, Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA 
t Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, Edith Wolfson, Medical Center, Holon, Israel 
u Department of Obstetrics and Gynecology, Queen Mary Hospital, Hong Kong, China 
v Department of Obstetrics and Gynecology, NTT East Sapporo Hospital, Sapporo, Japan 
w Niwa Clinic, Nisshin 458-0815, Japan 
x Department of Clinical Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Congella, South Africa 
y Rajiv Gandhi Centre for Biotechnology Thycaud, Kerala, India 
z Department of Genetics and Microbiology, University of Pavia, Pavia, Italy 
aa Department of Infectious, Parasitic and Immune-Mediated Disease, Istituto Superiore Sanità, Roma, Italy 
ab Gynaecological Cancer Research Center, UCL EGA Institute for Women’s Health, London, England 
ac Molecular and Human Genetics Division, Indian Institute of Chemical Biology, CSIR, Kolkata, India 
ad Molecular Medicine, Reliance Life Science, Navi Mumbai, India 
ae Faculty of Pharmacy- PUCRS, Porto Alegre, Brazil 
af Human Genetics Unit, Indian Statistical Institute, Kolkata, India 
ag Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand 
ah Department of Molecular Virology (E2), Graduate School of Medicine, Chiba University, Chiba, Japan 
ai Department of Pathology, Vrije Universiteit Medical Center, Amsterdam, Netherlands 
aj Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA 
ak Department of Medical Education and Research, 45 Hospital General Regional, Instituto Mexicano del Seguro Social, Guadalajara, Jal, Mexico 
al Department of Medical Microbiology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary 
am Department of Experimental Virology, National Reference Laboratory for Papillomaviruses, Institute of Hematology and Blood Transfusion, Prague, Czech Republic 
an Osaka Cancer Prevention and Detection Center, Osaka, Japan 
ao Department of Obstetrics and Gynecology, University Medical Centre Groningen, Groningen, Netherlands 
ap Institute of Pathology, University Hospital, Heidelberg, Germany 
aq Graduate Institute of Occupational Safety and Health and Department of Family Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan 
ar Department of Obstetrics and Gynecology, Hakodate Municipal Hospital, Hakodate, Japan 
as Thunder Bay Regional Research Institute, Thunder Bay, Ontario, Canada 

* Correspondence to: Dr Stefanie J Klug, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Johannes Gutenberg-University of Mainz, 55101 Mainz, Germany

Summary

Background

Cervical cancer is caused primarily by human papillomaviruses (HPV). The polymorphism rs1042522 at codon 72 of the TP53 tumour-suppressor gene has been investigated as a genetic cofactor. More than 80 studies were done between 1998 and 2006, after it was initially reported that women who are homozygous for the arginine allele had a risk for cervical cancer seven times higher than women who were heterozygous for the allele. However, results have been inconsistent. Here we analyse pooled data from 49 studies to determine whether there is an association between TP53 codon 72 polymorphism and cervical cancer.

Methods

Individual data on 7946 cases and 7888 controls from 49 different studies worldwide were reanalysed. Odds ratios (OR) were estimated using logistic regression, stratifying by study and ethnic origin. Subgroup analyses were done for infection with HPV, ethnic origin, Hardy–Weinberg equilibrium, study quality, and the material used to determine TP53 genotype.

Findings

The pooled estimates (OR) for invasive cervical cancer were 1·22 (95% CI 1·08–1·39) for arginine homozygotes compared with heterozygotes, and 1·13 (0·94–1·35) for arginine homozygotes versus proline homozygotes. Subgroup analyses showed significant excess risks only in studies where controls were not in Hardy–Weinberg equilibrium (1·71 [1·21–2·42] for arginine homozygotes compared with heterozygotes), in non-epidemiological studies (1·35 [1·15–1·58] for arginine homozygotes compared with heterozygotes), and in studies where TP53 genotype was determined from tumour tissue (1·39 [1·13–1·73] for arginine homozygotes compared with heterozygotes). Null results were noted in studies with sound epidemiological design and conduct (1·06 [0·87–1·29] for arginine homozygotes compared with heterozygotes), and studies in which TP53 genotype was determined from white blood cells (1·06 [0·87–1·29] for arginine homozygotes compared with heterozygotes).

Interpretation

Subgroup analyses indicated that excess risks were most likely not due to clinical or biological factors, but to errors in study methods. No association was found between cervical cancer and TP53 codon 72 polymorphism when the analysis was restricted to methodologically sound studies.

Funding

German Research Foundation (DFG).

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Vol 10 - N° 8

P. 772-784 - août 2009 Regresar al número
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