Against which human papillomavirus types shall we vaccinate and screen?: The international perspective
Against which human papillomavirus types shall we vaccinate and screen?: The international perspective
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DOI：
10.1002/ijc.20244
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发表时间：
2004-08-20
影响因子：
6.4
通讯作者：
Meijer, CJLM
中科院分区：
文献类型：
--
作者：
Muñoz, N;Bosch, FX;Meijer, CJLM
至少有15种类型的HPV与宫颈癌有关，但目前的HPV疫苗仅赋予类型特异性免疫力。为了确定宫颈癌中HPV类型分布的地理差异，我们对来自宫颈癌HPV类型国际调查和多中心病例对照研究的数据进行了汇总分析，两者均由IARC协调。研究病例是在25个国家招募的3，607名组织学确诊的宫颈癌患者。HPV DNA检测和分型在宫颈细胞或活检集中进行PCR检测。计算了HPV类型特异性疫苗预防的潜在病例数估计值和不同HPV筛查鸡尾酒有效性的变化。HPV DNA在96%的标本中检出，并检测到30种不同类型。最常见的15种类型按频率降序排列为16、18、45、31、33、52、58、35、59、56、39、51、73、68和66。北方非洲的16型比例高于平均水平，南亚的18型比例高于平均水平，撒哈拉以南非洲的45型比例高于平均水平，中美洲/南美洲的31型比例高于平均水平。包括16型和18型在内的疫苗可能预防全球71%的宫颈癌，但其对亚洲和欧洲/北美可能预防的病例百分比的影响更高。相比之下，含有7种最常见HPV类型的疫苗可以预防全球约87%的宫颈癌，区域差异很小。修改筛选鸡尾酒试验中的类型数量的影响很小，可能与筛选程序无关。(C)2004 Wiley-Liss，Inc.
At least 15 types of HPV have been associated with cervical cancer, but current HPV vaccines confer only type-specific immunity. To determine geographic variations in the HPV type distribution in cervical cancer, we carried out a pooled analysis of data from an international survey of HPV types in cervical cancer and from a multicenter case-control study, both co-coordinated by the IARC. Study cases were 3,607 women with incident, histologically confirmed cervical cancer recruited in 25 countries. HPV DNA detection and typing in cervical cells or biopsies were centrally done using PCR assays. Estimates of the potential number of cases prevented by HPV type-specific vaccines and changes in the validity of different HPV screening cocktails were calculated. HPV DNA was detected in 96% of specimens, and 30 different types were detected. The 15 most common types were, in descending order of frequency, 16, 18, 45, 3 1, 33, 52, 58, 35, 59, 56, 39, 51, 73, 68 and 66. Higher than average proportions of type 16 were found in northern Africa, of type 18 in south Asia, of type 45 in sub-Saharan Africa and of type 31 in Central/South America. A vaccine including types 16 and 18 could potentially prevent 71% of cervical cancers worldwide, but its impact with regard to the percentage of cases potentially prevented would be higher in Asia and Europe/North America. In contrast, a vaccine containing the 7 most common HPV types would prevent about 87% of cervical cancers worldwide, with little regional variation. The impact of modifying the number of types in the screening cocktail tests would be small and probably irrelevant for screening programs. (C) 2004 Wiley-Liss, Inc.