Updating the natural history of HPV and anogenital cancer
Updating the natural history of HPV and anogenital cancer
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DOI：
10.1016/j.vaccine.2006.06.018
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发表时间：
2006-08-31
期刊：
影响因子：
5.5
通讯作者：
Villa, Luisa L.
中科院分区：
文献类型：
--
作者：
Moscicki, Anna-Barbara;Schiffman, Mark;Villa, Luisa L.
宫颈癌发生的主要步骤包括宫颈转化区的化生上皮被12-18种致癌类型的人乳头瘤病毒（HPV）感染中的一种或多种感染、病毒持续存在、持续感染的上皮向宫颈癌前病变的克隆进展以及侵袭。虽然这些基本步骤已经确立，但几项新的流行病学研究揭示了影响这些转变的因素。转化区在宫颈癌中的重要性已经扩展到其他HPV诱导的癌症，如肛门癌或扁桃体癌。自然史研究表明，HPV与正常宫颈细胞学和宫颈上皮内瘤样病变（CIN）I级表现相似，大多数都显示消退。虽然这些研究已经证明了HPV持续存在在癌前病变CIN-3发展中的重要性，但从感染到CIN-3证据的时间从1年到10年不等。后来诊断的等同病变在其自然史上是否不同仍然未知。有几个因素与增强持久性和/或进展有关。然而，除了年龄之外，没有一个与这两个因素始终相关：年轻女性不太可能表现出持久性，而持久性的老年女性更有可能患浸润性癌症。最近的研究还强调了宿主免疫应答在清除已建立的感染中的重要性。最后，与宫颈感染相比，关于非宫颈HPV感染（如阴茎感染）的数据迄今为止是有限的。一些正在进行的队列研究应该让我们在不久的将来进一步了解伴侣感染。(c)2006爱思唯尔有限公司保留所有权利。
The major steps in cervical carcinogenesis include infection of the metaplastic epithelium of the cervical transformation zone with one or more of the 12-18 carcinogenic types of human papillomavirus (HPV) infection, viral persistence, clonal progression of the persistently-infected epithelium to cervical precancer, and invasion. Although these fundamental steps are established, several new epidemiologic studies have shed light on the factors that influence each of these transitions. The importance of the transformation zone in cervical cancer has been extended to other HPV-induced cancers such as anal or tonsillar cancers. Natural history studies show that HPV with normal cervical cytology and cervical intraepithelial neoplasia (CIN) grade I behave similarly, with the majority of both showing regression. Although these studies have demonstrated the importance of HPV persistence in the development of precancer CIN-3, the timing from infection to evidence of CIN-3 varies from I to 10 years. Whether equivalent lesions diagnosed later differ in their natural history remains unknown. Several factors have been implicated in enhancing persistence and/or progression. However, none are consistently associated with both except age: young women are less likely to show persistence and older women with persistence are more likely to be at risk of invasive cancer. Recent studies have also underscored the importance of the host immune response in clearance of established infections. Finally, data on non-cervical HPV infections, such as penile infections are limited to date compared to cervical infections. Several ongoing cohort studies should give us further insight into mate infections in the near future. (c) 2006 Elsevier Ltd. All rights reserved.