De Vuyst Hugo, Clifford Gary M, Nascimento Maria Claudia, Madeleine Margaret M, Franceschi Silvia
International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France.
Int J Cancer. 2009 Apr 1;124(7):1626-36. doi: 10.1002/ijc.24116.
This meta-analysis investigated human papillomavirus (HPV) prevalence in vulvar, vaginal and anal intraepithelial neoplasia (VIN, VAIN, AIN) grades 1-3 and carcinoma from 93 studies conducted in 4 continents and using PCR assays. Overall HPV prevalence was 67.8%, 85.3% and 40.4% among 90 VIN1, 1,061 VIN2/3 and 1,873 vulvar carcinomas; 100%, 90.1% and 69.9% among 107 VAIN1, 191 VAIN2/3 and 136 vaginal carcinomas; and 91.5%, 93.9% and 84.3% among 671 AIN1, 609 AIN2/3 and 955 anal carcinomas, respectively. HPV16 was found more frequently (>75%) and HPV18 less frequently (<10%) in HPV-positive vulvar, vaginal and anal carcinomas than in cervical carcinoma. HPV6 and 11 were common in VIN1 and AIN1, but not in VAIN1. HPV prevalence in vulvar carcinoma varied most by histological type (69.4% in warty-basaloid and 13.2% in keratinized type) and was also higher in women 60 years or younger and in studies carried out in North America. HPV prevalence in anal carcinoma was higher among women (90.8%) than men (74.9%), but no difference by gender emerged in North America. The majority of AIN2/3 derived from studies of HIV-positive individuals and/or men who have sex with men. Among AIN2/3, HIV infection was associated with higher HPV prevalence, more multiple-type infections and a relative under-representation of HPV16. In conclusion, approximately 40% of vulvar, 60% of vaginal and 80% of anal carcinoma may be avoided by prophylactic vaccines against HPV16/18. This proportion would be similar for the corresponding high-grade lesions of the vagina and anus, but higher for VIN2/3 (75%) than for vulvar carcinoma.
这项荟萃分析调查了在四大洲进行的93项研究中，采用聚合酶链反应（PCR）检测方法检测的1 - 3级外阴、阴道和肛门上皮内瘤变（VIN、VAIN、AIN）及癌组织中的人乳头瘤病毒（HPV）感染率。在90例VIN1、1061例VIN2/3和1873例外阴癌中，HPV总体感染率分别为67.8%、85.3%和40.4%；在107例VAIN1、191例VAIN2/3和136例阴道癌中，HPV总体感染率分别为100%、90.1%和69.9%；在671例AIN1、609例AIN2/3和955例肛门癌中，HPV总体感染率分别为91.5%、93.9%和84.3%。与宫颈癌相比，HPV阳性的外阴、阴道和肛门癌中HPV16的检出频率更高（>75%），而HPV18的检出频率更低（<10%）。HPV6和11在VIN1和AIN1中常见，但在VAIN1中不常见。外阴癌中HPV感染率因组织学类型差异最大（疣状基底样型为69.4%，角化型为13.2%），在60岁及以下女性以及北美开展的研究中也更高。肛门癌中女性的HPV感染率（90.8%）高于男性（74.9%），但在北美未发现性别差异。大多数AIN2/3来源于对HIV阳性个体和/或男男性行为者的研究。在AIN2/3中，HIV感染与更高的HPV感染率、更多的多重感染类型以及HPV16相对比例偏低有关。总之，针对HPV16/18的预防性疫苗可避免约40%的外阴癌、60%的阴道癌和80%的肛门癌。对于阴道和肛门相应的高级别病变，这一比例相似，但VIN2/3（75%）高于外阴癌。
