HPV-16 infection modifies overall survival of Puerto Rican HNSCC patients
Identifieur interne : 000010 ( Pmc/Checkpoint ); précédent : 000009; suivant : 000011HPV-16 infection modifies overall survival of Puerto Rican HNSCC patients
Auteurs : Bianca Rivera-Pe A [Porto Rico] ; Francisco J. Ruíz-Fullana [Porto Rico] ; Germán L. Vélez-Reyes [Porto Rico] ; Rosa J. Rodriguez-Benitez [Porto Rico] ; María J. Marcos-Martínez [Porto Rico] ; Juan Trinidad-Pinedo [Porto Rico] ; Adriana Báez [Porto Rico]Source :
- Infectious Agents and Cancer [ 1750-9378 ] ; 2016.
Abstract
HPV-16 modifies the overall survival (OS) of patients with oropharyngeal cancer (OPSCC). HPV-16 has been established as risk factor for OPSCC, but HPV-16 infection may also reside in the larynx and oral cavity. We evaluated HPV-16 status on OS of Head and Neck Squamous Cell Carcinoma (HNSCC) patients.
HPV-16 infection was confirmed by amplification of E6 and E7 viral oncogenes through PCR assay and E6 IHC in 185 HNSCC samples. Associations between HPV-16 status and clinicopathological parameters were performed using Fisher’s exact test and x2. Survival analysis was completed using Kaplan-Meier estimator and multivariate Cox regression analysis.
OS of HPV-16 positive patients was longer compared to HPV-16 negative patients (
HPV-16 status has a positive prognostic value in HNSCC. Addition of HPV-16 status to the TNM staging can provide better assessment in prognosis and guide treatment for HNSCC patients.
Url:
DOI: 10.1186/s13027-016-0095-4
PubMed: 27559359
PubMed Central: 4995614
Affiliations:
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">HPV-16 infection modifies overall survival of Puerto Rican HNSCC patients</title><author><name sortKey="Rivera Pe A, Bianca" sort="Rivera Pe A, Bianca" uniqKey="Rivera Pe A B" first="Bianca" last="Rivera-Pe A">Bianca Rivera-Pe A</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Biology, Natural Sciences Faculty, University of Puerto Rico, Rio Piedras Campus, San Juan, Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Department of Biology, Natural Sciences Faculty, University of Puerto Rico, Rio Piedras Campus, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation></author><author><name sortKey="Ruiz Fullana, Francisco J" sort="Ruiz Fullana, Francisco J" uniqKey="Ruiz Fullana F" first="Francisco J." last="Ruíz-Fullana">Francisco J. Ruíz-Fullana</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of Otolaryngology, Head and Neck Surgery Section, University of Puerto Rico, School of Medicine, PO Box 365067, San Juan, 00936 Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Department of Otolaryngology, Head and Neck Surgery Section, University of Puerto Rico, School of Medicine, PO Box 365067, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation></author><author><name sortKey="Velez Reyes, German L" sort="Velez Reyes, German L" uniqKey="Velez Reyes G" first="Germán L." last="Vélez-Reyes">Germán L. Vélez-Reyes</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Biology, Natural Sciences Faculty, University of Puerto Rico, Rio Piedras Campus, San Juan, Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Department of Biology, Natural Sciences Faculty, University of Puerto Rico, Rio Piedras Campus, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation></author><author><name sortKey="Rodriguez Benitez, Rosa J" sort="Rodriguez Benitez, Rosa J" uniqKey="Rodriguez Benitez R" first="Rosa J." last="Rodriguez-Benitez">Rosa J. Rodriguez-Benitez</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Department of General Social Sciences, University of Puerto Rico, Rio Piedras Campus, San Juan, Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Department of General Social Sciences, University of Puerto Rico, Rio Piedras Campus, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation></author><author><name sortKey="Marcos Martinez, Maria J" sort="Marcos Martinez, Maria J" uniqKey="Marcos Martinez M" first="María J." last="Marcos-Martínez">María J. Marcos-Martínez</name><affiliation wicri:level="1"><nlm:aff id="Aff4">Department of Pathology and Laboratory Medicine, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Department of Pathology and Laboratory Medicine, University of Puerto Rico, School of Medicine, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff5">Medical Services Administration, San Juan, Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Medical Services Administration, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation></author><author><name sortKey="Trinidad Pinedo, Juan" sort="Trinidad Pinedo, Juan" uniqKey="Trinidad Pinedo J" first="Juan" last="Trinidad-Pinedo">Juan Trinidad-Pinedo</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of Otolaryngology, Head and Neck Surgery Section, University of Puerto Rico, School of Medicine, PO Box 365067, San Juan, 00936 Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Department of Otolaryngology, Head and Neck Surgery Section, University of Puerto Rico, School of Medicine, PO Box 365067, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation></author><author><name sortKey="Baez, Adriana" sort="Baez, Adriana" uniqKey="Baez A" first="Adriana" last="Báez">Adriana Báez</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of Otolaryngology, Head and Neck Surgery Section, University of Puerto Rico, School of Medicine, PO Box 365067, San Juan, 00936 Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Department of Otolaryngology, Head and Neck Surgery Section, University of Puerto Rico, School of Medicine, PO Box 365067, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff6">Department of Pharmacology and Toxicology, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Department of Pharmacology and Toxicology, University of Puerto Rico, School of Medicine, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27559359</idno><idno type="pmc">4995614</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4995614</idno><idno type="RBID">PMC:4995614</idno><idno type="doi">10.1186/s13027-016-0095-4</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000044</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000044</idno><idno type="wicri:Area/Pmc/Curation">000044</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000044</idno><idno type="wicri:Area/Pmc/Checkpoint">000010</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000010</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">HPV-16 infection modifies overall survival of Puerto Rican HNSCC patients</title><author><name sortKey="Rivera Pe A, Bianca" sort="Rivera Pe A, Bianca" uniqKey="Rivera Pe A B" first="Bianca" last="Rivera-Pe A">Bianca Rivera-Pe A</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Biology, Natural Sciences Faculty, University of Puerto Rico, Rio Piedras Campus, San Juan, Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Department of Biology, Natural Sciences Faculty, University of Puerto Rico, Rio Piedras Campus, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation></author><author><name sortKey="Ruiz Fullana, Francisco J" sort="Ruiz Fullana, Francisco J" uniqKey="Ruiz Fullana F" first="Francisco J." last="Ruíz-Fullana">Francisco J. Ruíz-Fullana</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of Otolaryngology, Head and Neck Surgery Section, University of Puerto Rico, School of Medicine, PO Box 365067, San Juan, 00936 Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Department of Otolaryngology, Head and Neck Surgery Section, University of Puerto Rico, School of Medicine, PO Box 365067, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation></author><author><name sortKey="Velez Reyes, German L" sort="Velez Reyes, German L" uniqKey="Velez Reyes G" first="Germán L." last="Vélez-Reyes">Germán L. Vélez-Reyes</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Biology, Natural Sciences Faculty, University of Puerto Rico, Rio Piedras Campus, San Juan, Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Department of Biology, Natural Sciences Faculty, University of Puerto Rico, Rio Piedras Campus, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation></author><author><name sortKey="Rodriguez Benitez, Rosa J" sort="Rodriguez Benitez, Rosa J" uniqKey="Rodriguez Benitez R" first="Rosa J." last="Rodriguez-Benitez">Rosa J. Rodriguez-Benitez</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Department of General Social Sciences, University of Puerto Rico, Rio Piedras Campus, San Juan, Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Department of General Social Sciences, University of Puerto Rico, Rio Piedras Campus, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation></author><author><name sortKey="Marcos Martinez, Maria J" sort="Marcos Martinez, Maria J" uniqKey="Marcos Martinez M" first="María J." last="Marcos-Martínez">María J. Marcos-Martínez</name><affiliation wicri:level="1"><nlm:aff id="Aff4">Department of Pathology and Laboratory Medicine, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Department of Pathology and Laboratory Medicine, University of Puerto Rico, School of Medicine, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff5">Medical Services Administration, San Juan, Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Medical Services Administration, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation></author><author><name sortKey="Trinidad Pinedo, Juan" sort="Trinidad Pinedo, Juan" uniqKey="Trinidad Pinedo J" first="Juan" last="Trinidad-Pinedo">Juan Trinidad-Pinedo</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of Otolaryngology, Head and Neck Surgery Section, University of Puerto Rico, School of Medicine, PO Box 365067, San Juan, 00936 Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Department of Otolaryngology, Head and Neck Surgery Section, University of Puerto Rico, School of Medicine, PO Box 365067, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation></author><author><name sortKey="Baez, Adriana" sort="Baez, Adriana" uniqKey="Baez A" first="Adriana" last="Báez">Adriana Báez</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of Otolaryngology, Head and Neck Surgery Section, University of Puerto Rico, School of Medicine, PO Box 365067, San Juan, 00936 Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Department of Otolaryngology, Head and Neck Surgery Section, University of Puerto Rico, School of Medicine, PO Box 365067, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff6">Department of Pharmacology and Toxicology, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico</nlm:aff><country xml:lang="fr">Porto Rico</country><wicri:regionArea>Department of Pharmacology and Toxicology, University of Puerto Rico, School of Medicine, San Juan</wicri:regionArea><wicri:noRegion>San Juan</wicri:noRegion></affiliation></author></analytic><series><title level="j">Infectious Agents and Cancer</title><idno type="eISSN">1750-9378</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>HPV-16 modifies the overall survival (OS) of patients with oropharyngeal cancer (OPSCC). HPV-16 has been established as risk factor for OPSCC, but HPV-16 infection may also reside in the larynx and oral cavity. We evaluated HPV-16 status on OS of Head and Neck Squamous Cell Carcinoma (HNSCC) patients.</p></sec><sec><title>Methods</title><p>HPV-16 infection was confirmed by amplification of E6 and E7 viral oncogenes through PCR assay and E6 IHC in 185 HNSCC samples. Associations between HPV-16 status and clinicopathological parameters were performed using Fisher’s exact test and x<sup>2</sup>. Survival analysis was completed using Kaplan-Meier estimator and multivariate Cox regression analysis.</p></sec><sec><title>Results</title><p>OS of HPV-16 positive patients was longer compared to HPV-16 negative patients (<italic>P</italic> = 0.002). HPV-16 positive tumors of the larynx (LSCC) and pharynx (PSCC) showed improved OS compared to HPV-16 negative tumors. Also, HPV-16 positive patients exposed to radiotherapy presented a better survival.</p></sec><sec><title>Conclusions</title><p>HPV-16 status has a positive prognostic value in HNSCC. Addition of HPV-16 status to the TNM staging can provide better assessment in prognosis and guide treatment for HNSCC patients.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Ferlay, J" uniqKey="Ferlay J">J Ferlay</name></author><author><name sortKey="Shin, Hr" uniqKey="Shin H">HR Shin</name></author><author><name sortKey="Bray, F" uniqKey="Bray F">F Bray</name></author><author><name sortKey="Forman, D" uniqKey="Forman D">D Forman</name></author><author><name sortKey="Mathers, C" uniqKey="Mathers C">C Mathers</name></author><author><name sortKey="Parkin, Dm" uniqKey="Parkin D">DM Parkin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="O Orke, Ma" uniqKey="O Orke M">MA O’Rorke</name></author><author><name sortKey="Ellison, Mv" uniqKey="Ellison M">MV Ellison</name></author><author><name sortKey="Murray, Lj" uniqKey="Murray L">LJ Murray</name></author><author><name sortKey="Moran, M" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Infect Agent Cancer</journal-id><journal-id journal-id-type="iso-abbrev">Infect. Agents Cancer</journal-id><journal-title-group><journal-title>Infectious Agents and Cancer</journal-title></journal-title-group><issn pub-type="epub">1750-9378</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27559359</article-id><article-id pub-id-type="pmc">4995614</article-id><article-id pub-id-type="publisher-id">95</article-id><article-id pub-id-type="doi">10.1186/s13027-016-0095-4</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>HPV-16 infection modifies overall survival of Puerto Rican HNSCC patients</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes" equal-contrib="yes"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0001-8821-0210</contrib-id><name><surname>Rivera-Peña</surname><given-names>Bianca</given-names></name><address><phone>787-758-2525</phone><email>bianca.rivera@upr.edu</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Ruíz-Fullana</surname><given-names>Francisco J.</given-names></name><address><email>fjruiz77@gmail.com</email></address><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Vélez-Reyes</surname><given-names>Germán L.</given-names></name><address><email>velez192009@gmail.com</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Rodriguez-Benitez</surname><given-names>Rosa J.</given-names></name><address><email>rosa.rodriguez12@upr.edu</email></address><xref ref-type="aff" rid="Aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Marcos-Martínez</surname><given-names>María J.</given-names></name><address><email>maria.marcos@upr.edu</email></address><xref ref-type="aff" rid="Aff4">4</xref><xref ref-type="aff" rid="Aff5">5</xref></contrib><contrib contrib-type="author"><name><surname>Trinidad-Pinedo</surname><given-names>Juan</given-names></name><address><email>jtrinidadpi@hotmail.com</email></address><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Báez</surname><given-names>Adriana</given-names></name><address><email>adriana.baez@upr.edu</email></address><xref ref-type="aff" rid="Aff2">2</xref><xref ref-type="aff" rid="Aff6">6</xref></contrib><aff id="Aff1"><label>1</label>Department of Biology, Natural Sciences Faculty, University of Puerto Rico, Rio Piedras Campus, San Juan, Puerto Rico</aff><aff id="Aff2"><label>2</label>Department of Otolaryngology, Head and Neck Surgery Section, University of Puerto Rico, School of Medicine, PO Box 365067, San Juan, 00936 Puerto Rico</aff><aff id="Aff3"><label>3</label>Department of General Social Sciences, University of Puerto Rico, Rio Piedras Campus, San Juan, Puerto Rico</aff><aff id="Aff4"><label>4</label>Department of Pathology and Laboratory Medicine, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico</aff><aff id="Aff5"><label>5</label>Medical Services Administration, San Juan, Puerto Rico</aff><aff id="Aff6"><label>6</label>Department of Pharmacology and Toxicology, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico</aff></contrib-group><pub-date pub-type="epub"><day>24</day><month>8</month><year>2016</year></pub-date><pub-date pub-type="pmc-release"><day>24</day><month>8</month><year>2016</year></pub-date><pub-date pub-type="collection"><year>2016</year></pub-date><volume>11</volume><issue>1</issue><elocation-id>47</elocation-id><history><date date-type="received"><day>14</day><month>5</month><year>2016</year></date><date date-type="accepted"><day>29</day><month>7</month><year>2016</year></date></history><permissions><copyright-statement>© The Author(s). 2016</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p>HPV-16 modifies the overall survival (OS) of patients with oropharyngeal cancer (OPSCC). HPV-16 has been established as risk factor for OPSCC, but HPV-16 infection may also reside in the larynx and oral cavity. We evaluated HPV-16 status on OS of Head and Neck Squamous Cell Carcinoma (HNSCC) patients.</p></sec><sec><title>Methods</title><p>HPV-16 infection was confirmed by amplification of E6 and E7 viral oncogenes through PCR assay and E6 IHC in 185 HNSCC samples. Associations between HPV-16 status and clinicopathological parameters were performed using Fisher’s exact test and x<sup>2</sup>. Survival analysis was completed using Kaplan-Meier estimator and multivariate Cox regression analysis.</p></sec><sec><title>Results</title><p>OS of HPV-16 positive patients was longer compared to HPV-16 negative patients (<italic>P</italic> = 0.002). HPV-16 positive tumors of the larynx (LSCC) and pharynx (PSCC) showed improved OS compared to HPV-16 negative tumors. Also, HPV-16 positive patients exposed to radiotherapy presented a better survival.</p></sec><sec><title>Conclusions</title><p>HPV-16 status has a positive prognostic value in HNSCC. Addition of HPV-16 status to the TNM staging can provide better assessment in prognosis and guide treatment for HNSCC patients.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Head and neck squamous cell carcinoma</kwd><kwd>Human Papillomavirus (HPV)</kwd><kwd>Overall Survival (OS)</kwd><kwd>TNM</kwd><kwd>Biomarker</kwd></kwd-group><funding-group><award-group><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/10.13039/100000054</institution-id><institution>National Cancer Institute</institution></institution-wrap></funding-source><award-id>P20CA91402</award-id><award-id>U54CA96297</award-id></award-group><award-group><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/10.13039/100000057</institution-id><institution>National Institute of General Medical Sciences</institution></institution-wrap></funding-source><award-id>S06GM8224</award-id></award-group><award-group><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/http://dx.doi.org/10.13039/100000097</institution-id><institution>National Center for Research Resources</institution></institution-wrap></funding-source><award-id>G12RR03051</award-id></award-group><award-group><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/http://dx.doi.org/10.13039/100006545</institution-id><institution>National Institute on Minority Health and Health Disparities</institution></institution-wrap></funding-source><award-id>8G12MD007600</award-id></award-group></funding-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2016</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc><affiliations><list><country><li>Porto Rico</li></country></list><tree><country name="Porto Rico"><noRegion><name sortKey="Rivera Pe A, Bianca" sort="Rivera Pe A, Bianca" uniqKey="Rivera Pe A B" first="Bianca" last="Rivera-Pe A">Bianca Rivera-Pe A</name></noRegion><name sortKey="Baez, Adriana" sort="Baez, Adriana" uniqKey="Baez A" first="Adriana" last="Báez">Adriana Báez</name><name sortKey="Baez, Adriana" sort="Baez, Adriana" uniqKey="Baez A" first="Adriana" last="Báez">Adriana Báez</name><name sortKey="Marcos Martinez, Maria J" sort="Marcos Martinez, Maria J" uniqKey="Marcos Martinez M" first="María J." last="Marcos-Martínez">María J. Marcos-Martínez</name><name sortKey="Marcos Martinez, Maria J" sort="Marcos Martinez, Maria J" uniqKey="Marcos Martinez M" first="María J." last="Marcos-Martínez">María J. Marcos-Martínez</name><name sortKey="Rodriguez Benitez, Rosa J" sort="Rodriguez Benitez, Rosa J" uniqKey="Rodriguez Benitez R" first="Rosa J." last="Rodriguez-Benitez">Rosa J. Rodriguez-Benitez</name><name sortKey="Ruiz Fullana, Francisco J" sort="Ruiz Fullana, Francisco J" uniqKey="Ruiz Fullana F" first="Francisco J." last="Ruíz-Fullana">Francisco J. Ruíz-Fullana</name><name sortKey="Trinidad Pinedo, Juan" sort="Trinidad Pinedo, Juan" uniqKey="Trinidad Pinedo J" first="Juan" last="Trinidad-Pinedo">Juan Trinidad-Pinedo</name><name sortKey="Velez Reyes, German L" sort="Velez Reyes, German L" uniqKey="Velez Reyes G" first="Germán L." last="Vélez-Reyes">Germán L. Vélez-Reyes</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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