#IDIBELLfellows: Maria Brotons & Miguel Subias

Oral human papillomavirus (HPV) prevalence and risk factors among young adults in Spain
Maria Brotons Agulló –  Infections and Cancer
The proportion of HPV-related oropharyngeal cancers has increased in recent decades; however, the epidemiology of oral HPV infection remains poorly characterised. We aimed to estimate oral HPV prevalence by HPV vaccination status and examine risk factors for oral HPV among young adults in Catalonia, Spain. We conducted a cross-sectional study from 2019-2022. Unvaccinated men (18-26 years), vaccinated women from vaccinated cohorts (18-24 years) and unvaccinated women from unvaccinated cohorts (22-29 years) studying at university or holding a university degree were eligible. Participants provided a 1-minute oral rinse and gargle sample and a questionnaire on socio-demographic and behavioural data. HPV DNA detection and genotyping was performed using the SPF10 PCR-DEIA-LiPA25 system. We recruited 369 unvaccinated men, 621 unvaccinated and 620 vaccinated women. Oral HPV prevalence was higher in men than in vaccinated and unvaccinated women (7.6% vs. 2.9% and 1.9%, respectively; p=0.002 and p<0.001), with no statistically significant differences between the two female cohorts (p=0.353). Regarding genotypes targeted by bivalent or quadrivalent vaccines, only one HPV6 infection was detected in an unvaccinated woman. Oral HPV infection was independently associated with male sex, having two or more sexual partners in last 12 months, and illicit drug use, whereas inversely associated with gum bleeding history. The negligible prevalence of quadrivalent vaccine-types detected in unvaccinated young adults may reflect herd effects resulting from the HPV vaccination programme or a genuinely low circulation of these types in our setting.

Learning curve impact in robotic rectal cancer surgery (Catalonia, Spain)
Miguel Subias Burrel  – Health services research in cancer
Aim: Robotic surgery for rectal cancer has been gradually introduced in Catalonia over the last decade. We aimed to evaluate the learning curve for robotic rectal cancer surgery in Catalonia, Spain.
Methods: This multicentre cohort study included all robotic rectal cancer surgeries performed across 11 tertiary hospitals in Catalonia from 2019 to 2023. Through bivariate analysis, we compared patient characteristics, surgical/neoadjuvant treatment factors, postoperative complication and mortality rates according to centres’ years of robotic experience at the time of surgery. We then performed multivariate analyses to assess the impact of experience on the occurrence of postoperative complications and 6-month mortality, using hospitals with >5 years as the reference group.
Results: Our analysis included 871 resections: 124 performed in centres with less than 2 years’ experience, 308 in centres with 2 to 5 years’ experience, and 439 in centres with more than 5 years’ experience. Variables that showed a significant association with less experience (p < 0.05) were female sex, lower ASA grade, lower Charlson index, lower TNM stage, proximal tumour location, more frequent preoperative multidisciplinary team discussion, lower proportion of neoadjuvant treatment, shorter operation time, lower ICU admission, lower proportion of incomplete mesorectum, and fewer nodes removed. Multivariable analysis showed no association between experience and Clavien Dindo grade ≥ III postoperative complications (OR for < 2 vs > 5 years: 0.69, 95% CI 0.35 to 1.27; OR for 2-5 vs > 5 years: 0.73, 95% CI 0.47 to 1.13) or six-month mortality (HR for < 2 vs > 5 years: 0.63, 95% CI 0.14 to 2.88; HR for 2-5 vs > 5 years: 0.54, 95% CI 0.18 to 1.63).
Conclusions: Catalan tertiary hospitals have adopted robotic surgery incrementally, adjusting patient selection criteria at each stage of the learning
curve, with complexity increasing over time. This approach has not increased the risk of postoperative complications or 6-month mortality.