Department of Obstetrics and Gynaecology, University Hospitals Leuven/Campus Gasthuisberg, Catholic University Leuven, Leuven, Belgium.
Int J Cancer. 2011 Aug 15;129(4):903-9. doi: 10.1002/ijc.25745. Epub 2011 Feb 11.
The aim of this case-control study was to examine if type-specific human papillomavirus (HPV) DNA geno-typing before and after treatment of high-grade cervical intra-epithelial neoplasia (CIN) improves prediction of recurring or persisting CIN 2 or 3 compared with follow-up cytology or high-risk (hr)HPV testing. Women with biopsy-proven recurrence of CIN 2 or 3 (cases) in a follow-up period of at least 24 months after treatment of high-grade CIN were compared with women without recurrence (controls). These cohorts were identified by a database search of the Riatol Laboratoria (Antwerp, Belgium). In a cohort of 823 women treated with conisation for high-grade CIN between January 2001 and December 2007, 21 patients with a histologically proven recurrence of CIN2+ were identified. A group of women (n=42) from the same cohort without recurrence was randomly chosen. We found that hrHPV testing at 6 months post-treatment is significantly more sensitive compared with follow-up cytology (ratio: 1.31, 95% confidence interval (CI): 1.10-1.54), but less specific (ratio: 0.85, 95% CI: 0.81-0.90) to predict failure of treatment. When compared with hrHPV testing, HPV geno-typing is more efficient (equal sensitivity, but higher specificity, ratio: 1.43, 95% CI: 1.280-1.62). When compared with follow-up cytology, HPV geno-typing is more sensitive (ratio: 1.31, 95% CI: 1.10-1.54) and more specific (ratio: 1.22, 95% CI: 1.14-1.36). All women who developed a recurrence tested positive for hrHPV. The negative predictive value in the absence of hrHPV DNA was 100%. Six months after treatment HPV geno-typing is the most sensitive and specific method to predict recurrent or persistent CIN 2-3 in the next 24 months.
本病例对照研究旨在探讨治疗高级别宫颈上皮内瘤变（CIN）后进行 HPV 型别特异性 DNA 基因分型是否比随访细胞学或高危型（hr）HPV 检测更能预测 CIN 2 或 3 的复发或持续存在。对治疗后至少 24 个月随访时活检证实 CIN 2 或 3 复发的女性（病例）与未复发的女性（对照）进行比较。这些队列是通过对 Riatol Laboratoria（比利时安特卫普）的数据库进行搜索确定的。在 2001 年 1 月至 2007 年 12 月期间因高级别 CIN 接受子宫颈锥切术治疗的 823 名女性中，有 21 名患者的组织学证实存在 CIN2+复发。从同一队列中随机选择了一组未复发的女性（n=42）。我们发现，治疗后 6 个月时 hrHPV 检测的敏感性明显高于随访细胞学（比值：1.31，95%置信区间（CI）：1.10-1.54），但特异性较低（比值：0.85，95% CI：0.81-0.90），无法预测治疗失败。与 hrHPV 检测相比，HPV 基因分型更有效（灵敏度相同，但特异性更高，比值：1.43，95% CI：1.280-1.62）。与随访细胞学相比，HPV 基因分型更敏感（比值：1.31，95% CI：1.10-1.54），特异性更高（比值：1.22，95% CI：1.14-1.36）。所有发生复发的女性均检测到 hrHPV 阳性。在不存在 hrHPV DNA 的情况下，阴性预测值为 100%。治疗后 6 个月时，HPV 基因分型是预测未来 24 个月内 CIN 2-3 复发或持续存在的最敏感和最特异的方法。
