Human papillomavirus type 16 infections and 2-year absolute risk of cervical precancer in women with equivocal or mild cytologic abnormalities
Human papillomavirus type 16 infections and 2-year absolute risk of cervical precancer in women with equivocal or mild cytologic abnormalities
复制标题
DOI：
10.1093/jnci/dji186
复制
发表时间：
2005-07-20
影响因子：
10.3
通讯作者：
Wheeler, CM
中科院分区：
文献类型：
--
作者：
Castle, PE;Solomon, D;Wheeler, CM
背景在每年诊断为可疑或轻度异常细胞学检查的数百万妇女中，由人乳头瘤病毒16型（HPV16）感染引起的宫颈癌前病变的2年绝对风险尚未得到明确评估，HPV16是最常见的致癌HPV类型。研究方法：采用Hybrid Capture 2（HC2）和类型特异性L1共有引物聚合酶链反应检测了5060例细胞学可疑（意义不明的非典型鳞状细胞[ASCUS]）或轻度异常（低度鳞状上皮内病变[LSIL]）妇女的基线宫颈标本的HPV DNA。我们计算了在2年研究期间累积诊断为宫颈上皮内瘤变3级（CIN3）（n = 535）或宫颈癌（n = 7）（统称为CIN3）的绝对风险和95%置信区间（CI），并使用logistic回归比较了HPV16状态和其他致癌HPV类型的风险。所有统计学检验均为双侧检验。结果：宫颈细胞学诊断为ASCUS或LSIL的妇女中HPV 16的基线患病率分别为14.9%和21.1%。在基线时HPV 16 DNA阳性的ASCUS或LSIL细胞学检查的妇女，2年累积绝对风险>= CIN3分别为32.5%（95%CI = 28.4%至36.8%）和39.1%（95%CI = 33.8%至44.7%）。相比之下，HC2检测其他致癌HPV类型阳性的ASCUS女性合并>= CIN3的风险为8.4%（95%CI = 6.9%至10.4%），这与不了解致癌HPV DNA状态的ASCUS（风险= 8.8%，95%CI = 7.9%至9.8%）所造成的风险相似。HC2检测其他致癌HPV类型阳性的LSILs患者合并>= CIN3的2年风险为9.9%（95%CI = 8.0%~12.0%），低于不了解致癌HPV DNA状态的LSILs患者的风险（风险= 15.0%，95%CI = 13.3%~16.9%）。总之，与HPV阴性的女性相比，HPV 16阳性的ASCUS或LSIL女性发生>= CIN3的2年风险最高（比值比[OR]= 38，95%CI = 22至68; P
Background. The 2-year absolute risk for cervical precancer attributable to infection by human papillomavirus type 16 (HPV16), the most common and oncogenic HPV type, in the millions of women diagnosed annually with equivocal or mildly abnormal cytology has not been definitively evaluated. Methods: Baseline cervical specimens of 5060 women with equivocal (atypical squamous cells of undetermined significance [ASCUS]) or mildly abnormal (low-grade squamous intraepithelial lesion [LSIL]) cytology were tested for HPV DNA using Hybrid Capture 2 (HC2) and typespecific L1 consensus primer polymerase chain reaction. We calculated absolute risks with 95% confidence intervals (CIs) for cumulative diagnosis, during the 2-year study period, of cervical intraepithelial neoplasia grade 3 (CIN3) (n = 535) or cancer (n = 7) (collectively referred to as CIN3) and compared risk by HPV16 status and by other oncogenic HPV types using logistic regression. All statistical tests were two-sided. Results: The baseline prevalences of HPV16 in women with ASCUS or LSIL cytology were 14.9% and 21.1%, respectively. Women with ASCUS or LSIL cytology who were HPV16 DNA positive at baseline had 2-year cumulative absolute risks for >= CIN3 of 32.5% (95% CI = 28.4% to 36.8%) and 39.1% (95% CI = 33.8% to 44.7%), respectively. By comparison, women with ASCUS who were positive by HC2 for other oncogenic HPV types combined had an 8.4% (95% CI = 6.9% to 10.4%) risk for >= CIN3, which was similar to the risk posed by having ASCUS (risk = 8.8%, 95% CI = 7.9% to 9.8%) without knowledge of the oncogenic HPV DNA status. Women with LSILs who were positive by HC2 for other oncogenic HPV types combined had a 9.9% (95% CI = 8.0% to 12.0%) 2-year risk for >= CIN3, which was less than the risk posed by having LSILs (risk = 15.0%,95% CI = 13.3% to 16.9%) without knowledge of the oncogenic HPV DNA status. Together, women with ASCUS or LSILs who were HPV16-positive had the highest 2-year risk for >= CIN3 compared with women who were HPV-negative (odds ratio [OR] = 38, 95% CI = 22 to 68; P