Development of models for cervical cancer screening: construction in a cross-sectional population and validation in two screening cohorts in China.
Development of models for cervical cancer screening: construction in a cross-sectional population and validation in two screening cohorts in China.
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宫颈癌筛查模型的开发：横断面人群的建设和中国两个筛查同类群体的验证。
DOI：
10.1186/s12916-021-02078-2
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发表时间：
2021-09-03
期刊：
影响因子：
9.3
通讯作者：
Chen W
中科院分区：
文献类型：
--
作者：
Wu Z;Li T;Han Y;Jiang M;Yu Y;Xu H;Yu L;Cui J;Liu B;Chen F;Yin J;Zhang X;Pan Q;Qiao Y;Chen W
目前的宫颈癌筛查方法导致转诊数量增加和不必要的诊断程序。本研究旨在开发和评估一种更准确的宫颈癌筛查模型。在包括正常宫颈(N=1085)、宫颈上皮内瘤变(CIN，N=279)和宫颈癌(N=551)的横断面人群中，使用包括年龄、细胞学、高危人乳头瘤病毒(HrHPV)DNA/mRNA、E6癌蛋白、HPV基因分型和p16/Ki-67在内的多种预测因子来预测CIN2+或CIN3+。计算了使用年龄、细胞学和hrHPV的基本模型，并考虑了附加生物标记物的扩展版本。在两个筛查队列中进一步进行外部验证，随访3年(NCohort-I=3179，NCohort-II=3082)。在横断面人群中，与hrHPV和细胞学联合检测(AUC 0.80，95%CI=0.79-0.82，转诊率61.62，95%CI=59.4-63.8)相比，基础模型增加了曲线下面积(AUC，0.91，95%可信区间[CI]=0.88-0.93)，降低了阴道镜转诊率(42.76%，95%CI=38.67-46.92)。当基础模型中包括HPV基因分型和/或E6癌蛋白时，AUC进一步改善。两个筛查队列的外部验证进一步表明，我们的模型具有比常规筛查方法更好的临床表现，预测CIN2+的AUC分别为0.92(95%CI=0.91-0.93)和0.94(95%CI=0.91-0.97)，筛查队列I和II的转诊率分别为17.55%(95%CI=16.24-18.92)和7.40%(95%CI=6.50-8.38)。对CIN3+的预测也观察到了类似的结果。与常规筛查方法相比，我们的模型使用现有的宫颈筛查指标可以提高临床表现，降低转诊率。网上版载有补充材料，可在10.1186/s12916-021-02078-2查阅。
Current methods for cervical cancer screening result in an increased number of referrals and unnecessary diagnostic procedures. This study aimed to develop and evaluate a more accurate model for cervical cancer screening. Multiple predictors including age, cytology, high-risk human papillomavirus (hrHPV) DNA/mRNA, E6 oncoprotein, HPV genotyping, and p16/Ki-67 were used for model construction in a cross-sectional population including women with normal cervix (N = 1085), cervical intraepithelial neoplasia (CIN, N = 279), and cervical cancer (N = 551) to predict CIN2+ or CIN3+. A base model using age, cytology, and hrHPV was calculated, and extended versions with additional biomarkers were considered. External validations in two screening cohorts with 3-year follow-up were further conducted (NCohort-I = 3179, NCohort-II = 3082). The base model increased the area under the curve (AUC, 0.91, 95% confidence interval [CI] = 0.88–0.93) and reduced colposcopy referral rates (42.76%, 95% CI = 38.67–46.92) compared to hrHPV and cytology co-testing in the cross-sectional population (AUC 0.80, 95% CI = 0.79–0.82, referrals rates 61.62, 95% CI = 59.4–63.8) to predict CIN2+. The AUC further improved when HPV genotyping and/or E6 oncoprotein were included in the base model. External validation in two screening cohorts further demonstrated that our models had better clinical performances than routine screening methods, yielded AUCs of 0.92 (95% CI = 0.91–0.93) and 0.94 (95% CI = 0.91–0.97) to predict CIN2+ and referrals rates of 17.55% (95% CI = 16.24–18.92) and 7.40% (95% CI = 6.50–8.38) in screening cohort I and II, respectively. Similar results were observed for CIN3+ prediction. Compared to routine screening methods, our model using current cervical screening indicators can improve the clinical performance and reduce referral rates. The online version contains supplementary material available at 10.1186/s12916-021-02078-2.
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DOI：
10.1148/rg.2017160130
发表时间：
2017-03
期刊：
Radiographics : a review publication of the Radiological Society of North America, Inc
影响因子：
--
作者：
Erickson BJ;Korfiatis P;Akkus Z;Kline TL
通讯作者：
Kline TL
影响因子：
3.4
作者：
Pan, Qin-Jing;Hu, Shang-ying;Zhang, Xun;Ci, Pu-wa;Zhang, Wen-hua;Guo, Hui-qin;Cao, Jian;Zhao, Fang-hui;Lytwyn, Alice;Qiao, You-lin
通讯作者：
Qiao, You-lin
影响因子：
6.4
作者：
Yu, Lulu;Jiang, Mingyue;Qiao, You-Lin
通讯作者：
Qiao, You-Lin
影响因子：
2.3
作者：
Rothberg, Michael B.;Hu, Bo;Taksler, Glen B.
通讯作者：
Taksler, Glen B.
DOI：
10.1097/pgp.0b013e318159cbc0
发表时间：
2008-04-01
影响因子：
2.4
作者：
Branca, Margherita;Ciotti, Marco;Syrjanen, Kari
通讯作者：
Syrjanen, Kari