致癌性人乳头瘤病毒DNA呈阳性、细胞学检查呈阴性的女性后续巴氏涂片异常的绝对风险。

Absolute risk of a subsequent abnormal pap among oncogenic human papillomavirus DNA-positive, cytologically negative women.

作者信息

Castle Philip E, Wacholder Sholom, Sherman Mark E, Lorincz Attila T, Glass Andrew G, Scott David R, Rush Brenda B, Demuth Franklin, Schiffman Mark

机构信息

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.

出版信息

Cancer. 2002 Nov 15;95(10):2145-51. doi: 10.1002/cncr.10927.

DOI:10.1002/cncr.10927

PMID:12412168

Abstract

BACKGROUND

The addition of human papillomavirus (HPV) DNA testing to cytologic screening for cervical carcinoma is now being considered. The majority of women in screening cohorts who test positive for oncogenic types of HPV DNA have concurrent negative Pap tests. The absolute risk of a subsequent abnormal Pap test for these women is uncertain. Therefore, the proper counseling and clinical management of these women is also uncertain.

METHODS

A subcohort of 2020 women with a negative Pap test who tested positive at enrollment for oncogenic HPV DNA types using the Hybrid Capture 2 Test were followed for 57 months at Kaiser Permanente (Portland, OR). Absolute risks of new abnormal cytologic interpretations were computed using Kaplan-Meier methods. Logistic regression models were used to evaluate determinants of a new abnormal Pap test.

RESULTS

The cumulative incidence for a Pap test interpreted as atypical squamous cells or more severe (>or= ASC) was 16.8% (95% confidence interval [CI] = 15.0-18.6%), 6.4% (95% CI = 5.2-7.6%) for low-grade squamous intraepithelial lesions or more severe, and 2.2% (95% CI = 1.5-2.9%) for high-grade squamous intraepithelial lesions or more severe. By comparison, the cumulative incidence of greater than or equal to ASC among HPV-negative women was 4.2% (95% CI = 3.9-4.6%). The highest viral load (100 relative light units per the positive control or greater) was associated with a greater risk of an abnormal Pap test (odds ratio= 2.7, 95% CI = 1.7-4.1) than lower viral loads.

CONCLUSIONS

These results suggest that about 15% of women in annual screening programs who concurrently have a negative Pap test and a positive oncogenic HPV test will have a subsequent abnormal Pap test within 5 years. This risk estimate will be useful to the many clinicians and patients likely to be diagnosed with an HPV infection and negative cytology if HPV DNA is added to general screening.

摘要

背景

目前正在考虑将人乳头瘤病毒（HPV）DNA检测添加到宫颈癌的细胞学筛查中。在筛查队列中，大多数致癌型HPV DNA检测呈阳性的女性同时Pap试验结果为阴性。这些女性随后Pap试验异常的绝对风险尚不确定。因此，对这些女性进行适当的咨询和临床管理也不确定。

方法

对2020名Pap试验结果为阴性且使用杂交捕获2试验在入组时致癌性HPV DNA类型检测呈阳性的女性亚队列，在俄勒冈州波特兰的凯撒医疗集团进行了57个月的随访。使用Kaplan-Meier方法计算新的异常细胞学诊断的绝对风险。使用逻辑回归模型评估新的异常Pap试验的决定因素。

结果

Pap试验结果被解释为非典型鳞状细胞或更严重（≥ASC）的累积发病率为16.8%（95%置信区间[CI]=15.0-18.6%），低级别鳞状上皮内病变或更严重病变的累积发病率为6.4%（95%CI=5.2-7.6%），高级别鳞状上皮内病变或更严重病变的累积发病率为2.2%（95%CI=1.5-2.9%）。相比之下，HPV阴性女性中≥ASC的累积发病率为4.2%（95%CI=3.9-4.6%）。与较低病毒载量相比，最高病毒载量（每阳性对照100相对光单位或更高）与Pap试验异常风险更高相关（优势比=2.7，95%CI=1.7-4.1））。