Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group.
Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group.
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发表时间：
1995
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通讯作者：
F. Bosch;M. Manos;N. Muñoz;M. Sherman;A. Jansen;J. Peto;M. Schiffman;V. Moreno;R. Kurman
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作者：
F. Bosch;M. Manos;N. Muñoz;M. Sherman;A. Jansen;J. Peto;M. Schiffman;V. Moreno;R. Kurman
流行病学研究表明，生殖器人乳头瘤病毒（HPV）与宫颈癌的关联性很强，独立于其他风险因素，并且在几个国家一致。有20多种不同的癌症相关HPV类型，但对其地理变异知之甚少。我们的目的是确定HPV感染和宫颈癌之间的关系是否在世界范围内是一致的，并调查HPV类型分布的地理差异。方法：收集了22个国家32家医院的1000多例浸润性宫颈癌患者的标本，并冷冻保存。所有患者的切片均提交中心组织学审查，以确认诊断并评估组织学特征。我们使用聚合酶链反应为基础的检测能够检测超过25种不同的HPV类型。将广义线性泊松模型拟合到病毒类型和地理区域的数据，以评估地理异质性。结果HPV DNA在93%的肿瘤中检出，不同国家HPV阳性率无显著差异。HPV 16型占50%，HPV 18型占14%，HPV 45型占8%，HPV 31型占5%。HPV 16是所有国家的主要类型，但印度尼西亚除外，其中HPV 18更常见。一些不太常见的病毒类型的流行率存在显著的地理差异。HPV 45的聚集在西非很明显，而HPV 39和HPV 59几乎完全局限于中美洲和南美洲。在鳞状细胞肿瘤中，HPV 16占主导地位（51%），但HPV 18在腺癌（56%）和腺鳞癌（39%）中占主导地位。结论：我们的研究结果证实了生殖器HPV的作用，这是通过性传播的，是世界范围内宫颈癌的主要病因。他们还表明，大多数生殖器HPV与癌症有关，至少偶尔如此。超过20种不同的生殖器HPV类型与宫颈癌相关的证明对宫颈癌预防策略具有重要意义，包括针对生殖器HPV的疫苗的开发。
BACKGROUND Epidemiologic studies have shown that the association of genital human papillomavirus (HPV) with cervical cancer is strong, independent of other risk factors, and consistent in several countries. There are more than 20 different cancer-associated HPV types, but little is known about their geographic variation. PURPOSE Our aim was to determine whether the association between HPV infection and cervical cancer is consistent worldwide and to investigate geographic variation in the distribution of HPV types. METHODS More than 1000 specimens from sequential patients with invasive cervical cancer were collected and stored frozen at 32 hospitals in 22 countries. Slides from all patients were submitted for central histologic review to confirm the diagnosis and to assess histologic characteristics. We used polymerase chain reaction-based assays capable of detecting more than 25 different HPV types. A generalized linear Poisson model was fitted to the data on viral type and geographic region to assess geographic heterogeneity. RESULTS HPV DNA was detected in 93% of the tumors, with no significant variation in HPV positivity among countries. HPV 16 was present in 50% of the specimens, HPV 18 in 14%, HPV 45 in 8%, and HPV 31 in 5%. HPV 16 was the predominant type in all countries except Indonesia, where HPV 18 was more common. There was significant geographic variation in the prevalence of some less common virus types. A clustering of HPV 45 was apparent in western Africa, while HPV 39 and HPV 59 were almost entirely confined to Central and South America. In squamous cell tumors, HPV 16 predominated (51% of such specimens), but HPV 18 predominated in adenocarcinomas (56% of such tumors) and adenosquamous tumors (39% of such tumors). CONCLUSIONS Our results confirm the role of genital HPVs, which are transmitted sexually, as the central etiologic factor in cervical cancer worldwide. They also suggest that most genital HPVs are associated with cancer, at least occasionally. IMPLICATION The demonstration that more than 20 different genital HPV types are associated with cervical cancer has important implications for cervical cancer-prevention strategies that include the development of vaccines targeted to genital HPVs.