American University of Beirut Medical Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Bliss Street, Hamra District, Box: 113-6044/30C, Beirut, Lebanon.
Vaccine. 2011 Nov 15;29(49):9148-58. doi: 10.1016/j.vaccine.2011.09.115. Epub 2011 Oct 6.
Although cervical screening has led to a significant decline of invasive cervical cancer (ICC) in developed countries, it remains the third leading cause of cancer in women worldwide. While the majority of the decline in ICC can be attributed to a reduction in squamous cell carcinoma (SCC), the incidence of cervical adenocarcinoma (ADC), absolute and relative to SCC, has been rising steadily, especially in younger women. This paper examines oncogenic human papillomavirus (HPV) infections, the risk of developing cervical ADC and its prognosis. It analyzes differences between ADC and SCC and considers current and future methods for prevention.
PubMed, publicly available websites and congress abstracts were searched for data and literature.
HPV-16, -18 and -45 account for approximately 90% of ADC worldwide. Typically, α-7 genotypes, which include HPV-18 and -45, are more commonly associated with ADC than SCC. The difficulty in detecting ADC through screening as well as changing sexual habits and increased HPV transmission may account for its increase; an increase in SCC may not be observed because of improved detection of pre-malignant SCC compared with pre-malignant ADC. HPV testing shows promise for screening women ≥30years of age, but α-7 genotypes may be underrepresented in precancerous lesions. Clinical trial data indicate that current vaccines have high efficacy against HPV-16/18-related cervical intraepithelial neoplasia. Moreover, these vaccines also demonstrate a different level of protection beyond the HPV vaccine types, therefore increasing the overall vaccine efficacy. Such broad coverage could translate into a considerable reduction in the incidence of ADC.
Prophylactic HPV vaccination may have a significant impact on the prevention of ADC and may significantly impact future strategies for primary and secondary prevention of cervical cancer.
尽管宫颈筛查已显著降低发达国家的浸润性宫颈癌（ICC）发病率，但它仍是全球女性癌症的第三大主要病因。虽然 ICC 的大部分下降可归因于鳞状细胞癌（SCC）的减少，但宫颈腺癌（ADC）的发病率，包括其相对于 SCC 的绝对和相对发病率，一直在稳步上升，尤其是在年轻女性中。本文研究了致癌型人乳头瘤病毒（HPV）感染、发生宫颈 ADC 的风险及其预后。分析了 ADC 与 SCC 的差异，并考虑了当前和未来的预防方法。
通过 PubMed、公开网站和会议摘要搜索数据和文献。
全球范围内，HPV-16、-18 和 -45 约占 ADC 的 90%。通常，包括 HPV-18 和 -45 在内的 α-7 基因型与 ADC 的相关性大于 SCC。由于通过筛查难以检测到 ADC，以及性行为习惯的改变和 HPV 传播的增加，可能导致其发病率上升；而 SCC 的发病率可能不会增加，因为与 ADC 相比，SCC 的癌前病变的检测得到了改善。HPV 检测对筛查年龄≥30 岁的女性有一定前景，但在癌前病变中，α-7 基因型可能代表性不足。临床试验数据表明，目前的疫苗对 HPV-16/18 相关宫颈上皮内瘤变具有很高的疗效。此外，这些疫苗在 HPV 疫苗类型之外还表现出不同程度的保护作用，从而提高了整体疫苗效力。这种广泛的覆盖范围可能会显著降低 ADC 的发病率。
预防性 HPV 疫苗接种可能对预防 ADC 产生重大影响，并可能对宫颈癌初级和二级预防的未来策略产生重大影响。
