Clinical Progression of High-Grade Cervical Intraepithelial Neoplasia: Estimating the Time to Preclinical Cervical Cancer From Doubly Censored National Registry Data
Clinical Progression of High-Grade Cervical Intraepithelial Neoplasia: Estimating the Time to Preclinical Cervical Cancer From Doubly Censored National Registry Data
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DOI：
10.1093/aje/kwt077
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发表时间：
2013-10-01
影响因子：
5
通讯作者：
Berkhof, Johannes
中科院分区：
文献类型：
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作者：
Vink, Margaretha A.;Bogaards, Johannes A.;Berkhof, Johannes
人们对从高级别宫颈上皮内瘤变（CIN2/3）进展为浸润性宫颈癌的时间跨度知之甚少。不允许根据纵向研究估计该持续时间，因为 CIN2/3 应在检测到时进行治疗。国家登记处很容易获得有关检测到的 CIN2/3 和宫颈癌病例的年龄特定发病率的横断面数据，但这些数据很难解释，因为既没有观察到病变发展的时刻，也没有观察到浸润性癌症的发作。我们利用荷兰国家登记处开发了一个统计模型，用于估计 20002005 年 CIN2/3 和临床前癌症之间的持续时间。使用人乳头瘤病毒 (HPV) 基因型数据来区分 CIN2/3 和癌症发病率，以获得 HPV-16 阳性和 HPV-16 阴性病变的估计值。从 CIN2/3 到癌症的中位时间估计为 23.5 年（95 置信区间：20.8，26.6），1.6 个病变在 10 年内进展为癌症。 HPV-16 阳性病变的中位持续时间相似，但 2.4 的 HPV-16 阳性病变在 10 年内进展为癌症，而 HPV-16 阴性病变的中位持续时间为 0.6。根据疫苗接种和新的筛查测试，估计癌症发生时间对于重新评估最佳筛查间隔至关重要。
Little is known about the time span of progression from high-grade cervical intraepithelial neoplasia (CIN2/3) to invasive cervical cancer. Estimation of this duration from longitudinal studies is not permitted, as CIN2/3 should be treated when detected. Cross-sectional data on the age-specific incidence of detected CIN2/3 and cervical cancer cases are readily available in national registries, but these data are difficult to interpret because neither the moment of lesion development nor the onset of invasive cancer is observed. We developed a statistical model for estimating the duration of time between CIN2/3 and preclinical cancer using Dutch national registries for the years 20002005. Human papillomavirus (HPV) genotype data were used to separate CIN2/3 and cancer incidences to obtain estimates for HPV-16-positive and HPV-16-negative lesions. The median time from CIN2/3 to cancer was estimated to be 23.5 years (95 confidence interval: 20.8, 26.6), and 1.6 of the lesions progressed to cancer within 10 years. The median duration for HPV-16-positive lesions was similar, but 2.4 of the HPV-16-positive lesions progressed to cancer within 10 years, as compared with 0.6 for HPV-16-negative lesions. Estimated durations of time to cancer are essential for reassessment of the optimal screening interval in light of vaccination and novel screening tests.