Human papillomavirus infection and time to progression and regression of cervical intraepithelial neoplasia
Human papillomavirus infection and time to progression and regression of cervical intraepithelial neoplasia
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DOI：
10.1093/jnci/djg037
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发表时间：
2003-09-03
影响因子：
10.3
通讯作者：
Franco, EL
中科院分区：
文献类型：
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作者：
Schlecht, NF;Platt, RW;Franco, EL
背景：宫颈癌前病变的持续时间与人乳头瘤病毒（HPV）感染的关系知之甚少。我们根据HPV状态估计了宫颈鳞状上皮内病变（锡尔斯）的进展率、消退率和逗留时间。方法：我们使用的数据来自巴西圣保罗的HPV感染和宫颈肿瘤的纵向研究。在8年的时间里，每4-6个月从2404名妇女中采集宫颈标本进行巴氏细胞学和聚合酶链反应HPV检测。我们使用精算和非精算分析来测量根据HPV感染的状态和类型的病变进展和消退的时间和速率。结果如下：在随访期间，检测到118例低度SIL（LSIL），24例高度SIL（HSIL）和173例意义不明的非典型鳞状细胞（ASCUS）事件。与未感染HPV的女性相比，携带致癌HPV类型的女性从ASCUS进展至LSIL或更差以及从LSIL进展至HSIL或更差的平均时间更短（在有致癌HPV和无HPV的女性中，ASCUS进展的平均时间分别为67.0和88.0个月，差异= 21.0个月，95%置信区间[CI] = 11.3至30.7个月; LSIL进展的平均时间分别为73.3和83.5个月，差异= 10.2个月，95% CI = -0.15至20.6个月）。半数LSIL在6个月内恢复正常或ASCUS。对于致癌HPV类型的女性，从ASCUS到正常，从LSIL到ASCUS或正常，从HSIL/宫颈上皮内瘤变2到ASCUS或正常的平均时间较长（16.8个月，95% CI = 7.5至26.2个月; 13.8个月，95% CI = 8.8至18.7个月;和17.1个月，95% CI分别为4.1至30.1个月）（7.7个月，95% CI = 5.2至10.2个月; 7.8个月，95% CI = 5.3至10.2个月; 8.9个月，95% CI = 3.3至14.6个月）或无HPV感染的女性（分别为7.6个月，95% CI = 6.9 - 8.4个月; 7.6个月，95% CI = 6.4 - 8.7个月; 7.0个月，95% CI = 5.0 - 8.9个月）。结论：与非致癌性感染或无HPV感染的女性相比，致癌性HPV感染的女性宫颈前体病变持续时间更长，进展更快。检测宫颈病变的致癌HPV可能有助于识别那些可能迅速进展的HPV。
Background: Little is known about the duration of precancerous cervical lesions in relation to human papillomavirus (HPV) infection. We estimated rates of progression and regression and sojourn times of cervical squamous intraepithelial lesions (SILs) according to HPV status. Methods: We used data from a longitudinal study of HPV infection and cervical neoplasia in Sao Paulo, Brazil. Cervical specimens were taken from 2404 women for Pap cytology and polymerase chain reaction-based HPV testing every 4-6 months over a period of 8 years. We used actuarial and non-actuarial analyses to measure time to and rates of lesion progression and regression according to status and type of HPV infection. Results: During follow-up, 118 low-grade SIL (LSIL), 24 high-grade SIL (HSIL), and 173 atypical squamous cells of undetermined significance (ASCUS) events were detected. Mean time to progression from ASCUS to LSIL or worse and from LSIL to HSIL or worse was shorter in women with oncogenic HPV types than in women with no HPV infection (mean times for ASCUS progression were 67.0 and 88.0 months, respectively, in women with oncogenic HPV and no HPV, difference = 21.0 months, 95% confidence interval [CI] = 11.3 to 30.7 months; mean times for LSIL progression were 73.3 and 83.5 months, respectively, difference = 10.2 months, 95% CI = -0.15 to 20.6 months). Half of the LSILs regressed to normal or ASCUS within 6 months. Mean times for regression from ASCUS to normal, from LSIL to ASCUS or normal, and from HSIL/cervical intraepithelial neoplasia 2 to ASCUS or normal were longer for women with oncogenic HPV types (16.8 months, 95% CI = 7.5 to 26.2 months; 13.8 months, 95% CI = 8.8 to 18.7 months; and 17.1 months, 95% CI = 4.1 to 30.1 months, respectively) than for women with non-oncogenic HPV types (7.7 months, 95% CI = 5.2 to 10.2 months; 7.8 months, 95% CI = 5.3 to 10.2 months; 8.9 months, 95% CI = 3.3 to 14.6 months) or for women with no HPV infection (7.6 months, 95% CI = 6.9 to 8.4 months; 7.6 months, 95% CI = 6.4 to 8.7 months; and 7.0 months, 95% CI = 5.0 to 8.9 months, respectively). Conclusion: Precursor lesions of the cervix persist longer and progress more quickly in women with oncogenic HPV infections than in women with non-oncogenic infections or without HPV. Testing cervical lesions for oncogenic HPVs may help identify those that are likely to progress rapidly.