Human papillomavirus types in 115,789 HPV-positive women: A meta-analysis from cervical infection to cancer
Human papillomavirus types in 115,789 HPV-positive women: A meta-analysis from cervical infection to cancer
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DOI：
10.1002/ijc.27485
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发表时间：
2012-11-15
影响因子：
6.4
通讯作者：
Clifford, Gary M.
中科院分区：
文献类型：
--
作者：
Guan, Peng;Howell-Jones, Rebecca;Clifford, Gary M.
基因分型可能会改善高危（HR）人乳头瘤病毒（HPV）阳性妇女在宫颈筛查计划的风险分层;然而，前瞻性数据比较的自然史和致癌潜力的个别HR类型仍然有限。对115，789例HPV阳性女性的横断面HR HPV类型分布进行了荟萃分析，其中包括33，154例正常细胞学检查，6，810例意义不明的非典型鳞状细胞（ASCUS），13，480例低度鳞状上皮内病变（LSIL）和6，616例高度SIL（HSIL），8，来自全球423项基于PCR的研究的106例1级宫颈上皮内瘤变（CIN 1）、4，068例CIN 2和10，753例CIN 3，以及36，374例浸润性宫颈癌（ICC）。HPV类型分布在正常细胞学、ASCUS、LSIL或CIN 1之间没有明显差异。HPV 16阳性率从正常/ASCUS/LSIL/CIN 1（2028%）、CIN 2/HSIL（40/47%）到CIN 3/ICC（58/63%）急剧上升。HPV 16、18和45型在ICC中占HPV感染的比例大于或等于正常细胞学（ICC：正常比率分别为3.07、1.87和1.10）和CIN 3（ICC：CIN 3比率分别为1.08、2.11和1.47）。其他HR类型占HPV阳性CIN 2和CIN 3的重要比例，但它们在ICC中的贡献下降，ICC：正常比率范围从HPV 33的0.94下降到HPV 51的0.16。ICC：HPV 45在非洲（1.85）和南美洲/中美洲（1.79）以及HPV 58在东亚（1.36）的正常比率特别高。ASCUS和LSIL似乎是HPV感染的代表，而不是癌症的前兆，甚至CIN 3也不能完全代表引起ICC的类型。特别是HPV 16，还有HPV 18和45，在基于HPV的筛查计划中值得特别关注。
Genotyping may improve risk stratification of high-risk (HR) human papillomavirus (HPV)-positive women in cervical screening programs; however, prospective data comparing the natural history and carcinogenic potential of individual HR types remain limited. A meta-analysis of cross-sectional HR HPV-type distribution in 115,789 HPV-positive women was performed, including 33,154 normal cytology, 6,810 atypical squamous cells of undetermined significance (ASCUS), 13,480 low-grade squamous intraepithelial lesions (LSIL) and 6,616 high-grade SIL (HSIL) diagnosed cytologically, 8,106 cervical intraepithelial neoplasia grade 1 (CIN1), 4,068 CIN2 and 10,753 CIN3 diagnosed histologically and 36,374 invasive cervical cancers (ICCs) from 423 PCR-based studies worldwide. No strong differences in HPV-type distribution were apparent between normal cytology, ASCUS, LSIL or CIN1. However, HPV16 positivity increased steeply from normal/ASCUS/LSIL/CIN1 (2028%), through CIN2/HSIL (40/47%) to CIN3/ICC (58/63%). HPV16, 18 and 45 accounted for a greater or equal proportion of HPV infections in ICC compared to normal cytology (ICC:normal ratios = 3.07, 1.87 and 1.10, respectively) and to CIN3 (ICC:CIN3 ratios = 1.08, 2.11 and 1.47, respectively). Other HR types accounted for important proportions of HPV-positive CIN2 and CIN3, but their contribution dropped in ICC, with ICC:normal ratios ranging from 0.94 for HPV33 down to 0.16 for HPV51. ICC:normal ratios were particularly high for HPV45 in Africa (1.85) and South/Central America (1.79) and for HPV58 in Eastern Asia (1.36). ASCUS and LSIL appear proxies of HPV infection rather than cancer precursors, and even CIN3 is not entirely representative of the types causing ICC. HPV16 in particular, but also HPV18 and 45, warrant special attention in HPV-based screening programs.