Bosch F Xavier, de Sanjosé Silvia
Epidemiology and Cancer Registration Unit, Catalan Institute of Oncology, Avda. Gran Via, s/n Km 2,7, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
J Natl Cancer Inst Monogr. 2003(31):3-13. doi: 10.1093/oxfordjournals.jncimonographs.a003479.
Cervical cancer remains the second most common cancer in women worldwide and the most frequent in developing countries. Pre-neoplasic cervical lesions represent an additional burden in countries where screening is widespread. The human papillomavirus (HPV) prevalence and type distribution in normal smears and in cancer specimens are being described and show relatively small international variation. State-of-the-art detection techniques have unequivocally shown that HPV-DNA can be detected in 95% to 100% of adequate specimens of cervical cancer, supporting the claim that HPV is the necessary cause. The odds ratios for cervical cancer related to a cross sectional detection of HPV-DNA range from 50 to several hundred in all studies. The risk for any of 15 high-risk types is not statistically different from the risk reported for HPV16. The estimates of the attributable fraction range from 90% to 98%. Additional work should be done in providing information on incidence of cervical cancer and on HPV infection in areas where the disease is common. Theoretical work including modeling of the incidence could be of potential use in the evaluation of the existing and novel preventive strategies. Research is currently being conducted on the mechanisms of HPV carcinogenesis. These include the determinants of the systemic and cellular immune response to the viral infection, the interaction between the host and the virus and the relevance of the different strains and variants of the HPV viral types. Technology developments in this area suitable for epidemiological studies are needed.
宫颈癌仍然是全球女性中第二大常见癌症，在发展中国家最为频发。在广泛开展筛查的国家，癌前宫颈病变是额外的负担。目前正在描述人乳头瘤病毒（HPV）在正常涂片和癌症标本中的流行率及类型分布，结果显示国际间差异相对较小。先进的检测技术已明确表明，在95%至100%的宫颈癌合格标本中可检测到HPV-DNA，这支持了HPV是必要病因的说法。在所有研究中，与HPV-DNA横断面检测相关的宫颈癌比值比范围为50至数百。15种高危型别中任何一种的风险与HPV16报告的风险在统计学上无差异。归因分数估计值范围为90%至98%。在宫颈癌常见地区，应开展更多工作以提供宫颈癌发病率和HPV感染情况的信息。包括发病率建模在内的理论工作可能对评估现有和新型预防策略有潜在用途。目前正在对HPV致癌机制进行研究。这些机制包括对病毒感染的全身和细胞免疫反应的决定因素、宿主与病毒之间的相互作用以及HPV病毒型别的不同菌株和变体的相关性。需要在该领域开发适用于流行病学研究的技术。
