编者按
新一轮的ASCCP宫颈癌筛查和管理指南推荐临床决策主要依据宫颈癌或癌前病变的发生风险进行制订,而非依赖于检查结果。本文通过联合宫颈癌或癌前病变重要预测因子——HPV和细胞学检查结果,给出了这种筛查策略下的初步风险评估。
Risks of CIN 2+, CIN 3+, and Cancer by Cytology and Human Papillomavirus Status: The Foundation of Risk-Based Cervical Screening Guidelines
目的
新一轮的ASCCP宫颈癌筛查和管理指南将会推荐根据宫颈癌/癌前病变的发生风险而非依赖于检查结果的路线图进行临床决策。本文通过联合2个最重要的预测因子——HPV和细胞学检查结果,给出了这种筛查策略下的初步风险评估。
Objectives: The next round of the American Society for Colposcopy and Cervical Pathology (ASCCP)-sponsored cervical cancer screening and management guidelines will recommend clinical actions based on risk, rather than test-based algorithms. This article gives preliminary risk estimates for the screening setting, showing combinations of the 2 most important predictors, human papillomavirus (HPV) status and cytology result.
材料和方法
我们选择了年龄在25岁至77岁之间,于加州北部的凯撒医疗集团进行HPV DNA(HC2,Qiagen)和细胞学检查联合检测的1,262,713名女性作为研究对象,并通过联合细胞学检查结果(NILM,ASC-US,LSIL,ASC-H,HSIL,AGC)和HPV感染状态,对被纳入人群5年中发生CIN 2+,CIN 3+和宫颈癌的累积风险进行评估。
Materials and Methods: Among 1,262,713 women aged 25 to 77 years co-tested with HC2 (Qiagen) and cytology at Kaiser Permanente Northern California, we estimated 0–5-year cumulative risk of cervical intraepithelial neoplasia (CIN) 2+, CIN 3+, and cancer for combinations of cytology (negative for intraepithelial lesion or malignancy [NILM], atypical squamous cells of undetermined significance [ASC-US], low-grade squamous intraepithelial lesion [LSIL], atypical squamous cells cannot exclude HSIL [ASC-H], high-grade squamous intraepithelial lesion [HSIL], atypical glandular cells [AGC]) and HPV status.
结果
90%接受筛查的女性检查结果为HPV阴性的NILM,其后续发生癌症的风险极低。 与NILM(0.25%)的妇女相比,HPV阴性(0.12%)的妇女罹患CIN 3+的5年危险度更低。在HPV阴性妇女中,根据细胞学检查结果的不同,罹患CIN 3+的5年危险度如下:细胞学NILM0.10%,ASC-US为0.44%,LSIL为1.8%,ASC-H为3.0%,AGC为1.2%,HSIL+(非常罕见的)达29%。在HPV阳性女性中,根据细胞学检查结果的不同,罹患CIN 3+的5年危险度如下:NILM为4.0%,ASC-US为6.8%,LSIL为6.1%,ASC-H为28%,AGC为30%,HSIL +为50%。
Results: Ninety percent of screened women had HPV-negative NILM and an extremely low risk of subsequent cancer. Five-year risks of CIN 3+ were lower after HPV negativity (0.12%) than after NILM (0.25%). Among HPV-negative women, 5-year risks for CIN 3+ were 0.10% for NILM, 0.44% for ASC-US, 1.8% for LSIL, 3.0% for ASC-H, 1.2% for AGC, and 29% for HSIL+ cytology (which was very rare). Among HPV-positive women, 5-year risks were 4.0% for NILM, 6.8% for ASC-US, 6.1% for LSIL, 28% for ASC-H, 30% for AGC, and 50% for HSIL+ cytology.
结论
作为下一版指南修订的基础,我们更精确地确认了先前根据HPV和细胞学联合检测结果得出的风险预计值。未来的分析将会对在阴道镜门诊就诊和治疗后的妇女进行相关风险预测,并会考虑到年龄、是否接种HPV疫苗、HPV类型、筛查和治疗史等因素对发生CIN 2+,CIN 3+和宫颈癌风险的影响。
Conclusions: As a foundation for the next guidelines revision, we confirmed with additional precision the risk estimates previously reported for combinations of HPV and cytology. Future analyses will estimate risks for women being followed in colposcopy clinic and posttreatment and will consider the role of risk modifiers such as age, HPV vaccine status, HPV type, and screening and treatment history.
参考文献:
Demarco M, Lorey TS, Fetterman B, Cheung LC, Guido RS, Wentzensen N, Kinney WK, Poitras NE, Befano B, Castle PE, Schiffman M. Risks of CIN 2+, CIN 3+, and Cancer by Cytology and Human Papillomavirus Status: The Foundation of Risk-Based Cervical Screening Guidelines. J Low Genit Tract Dis. Oct;21(4):261-267.
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撰稿 | 陈旭豪
编辑 | 李旭
责任编辑 | 王璐
审稿 | 谢通 江路
审核 | 陶霞
通过HPV和细胞学检测结果预测CIN 2+ CIN 3+和宫颈癌的发生风险:基于风险的宫颈癌筛查指南的修订基础
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