人乳头瘤病毒在疫苗引入前美国浸润性外阴癌和外阴上皮内瘤变 3 型中的流行情况。
Prevalence of human papillomavirus types in invasive vulvar cancers and vulvar intraepithelial neoplasia 3 in the United States before vaccine introduction.
机构信息
Epidemic Intelligence Service, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
出版信息
J Low Genit Tract Dis. 2012 Oct;16(4):471-9. doi: 10.1097/LGT.0b013e3182472947.
OBJECTIVE
The study aimed to determine the baseline prevalence of human papillomavirus (HPV) types in invasive vulvar cancer (IVC) and vulvar intraepithelial neoplasia 3 (VIN 3) cases using data from 7 US cancer registries.
MATERIALS AND METHODS
Registries identified eligible cases diagnosed in 1994 to 2005 and requested pathology laboratories to prepare 1 representative block for HPV testing on those selected. Hematoxylin-eosin-stained sections preceding and following those used for extraction were reviewed to confirm representation. Human papillomavirus was detected using L1 consensus polymerase chain reaction (PCR) with PGMY9/11 primers and type-specific hybridization, with retesting of samples with negative and inadequate results with SPF10 primers. For IVC, the confirmatory hematoxylin-eosin slides were re-evaluated to determine histological type. Descriptive analyses were performed to examine distributions of HPV by histology and other factors.
RESULTS
Human papillomavirus was detected in 121/176 (68.8%) cases of IVC and 66/68 (97.1%) cases of VIN 3 (p < .0001). Patients with IVC and VIN 3 differed by median age (70 vs 55 y, p = .003). Human papillomavirus 16 was present in 48.6% of IVC cases and 80.9% of VIN 3 cases; other high-risk HPV was present in 19.2% of IVC cases and 13.2% of VIN 3 cases. Prevalence of HPV differed by squamous cell carcinoma histological subtype (p < .0001) as follows: keratinizing, 49.1% (n = 55); nonkeratinizing, 85.7% (n = 14), basaloid, 92.3% (n = 14), warty 78.2% (n = 55), and mixed warty/basaloid, 100% (n = 7).
CONCLUSIONS
Nearly all cases of VIN 3 and two thirds of IVC cases were positive for high-risk HPV. Prevalence of HPV ranged from 49.1% to 100% across squamous cell carcinoma histological subtypes. Given the high prevalence of HPV in IVC and VIN 3 cases, prophylactic vaccines have the potential to decrease the incidence of vulvar neoplasia.
目的
本研究旨在利用来自 7 个美国癌症登记处的数据，确定浸润性外阴癌（IVC）和外阴上皮内瘤变 3 级（VIN3）病例中人类乳头瘤病毒（HPV）类型的基线流行率。
材料和方法
登记处确定了 1994 年至 2005 年期间诊断的合格病例，并要求病理实验室为选定的病例准备 1 个代表性的组织块进行 HPV 检测。对用于提取之前和之后的苏木精-伊红染色切片进行回顾性分析，以确认代表性。使用 L1 保守聚合酶链反应（PCR）与 PGMY9/11 引物和型特异性杂交检测 HPV，对阴性和结果不足的样本进行 SPF10 引物的重复检测。对于 IVC，对确认性的苏木精-伊红切片进行重新评估，以确定组织学类型。进行描述性分析以检查 HPV 按组织学和其他因素的分布。
结果
在 176 例 IVC 病例和 68 例 VIN3 病例中（p<0.0001），检测到 HPV 121/176（68.8%）和 66/68（97.1%）。IVC 患者和 VIN3 患者的中位年龄不同（70 岁 vs 55 岁，p=0.003）。HPV16 存在于 48.6%的 IVC 病例和 80.9%的 VIN3 病例中；19.2%的 IVC 病例和 13.2%的 VIN3 病例存在其他高危 HPV。HPV 的流行率因鳞状细胞癌组织学亚型而异（p<0.0001），如下所示：角化型，49.1%（n=55）；非角化型，85.7%（n=14），基底细胞样型，92.3%（n=14），疣状型，78.2%（n=55），混合疣状/基底细胞样型，100%（n=7）。
结论
几乎所有的 VIN3 病例和三分之二的 IVC 病例都为高危 HPV 阳性。HPV 的流行率在鳞状细胞癌组织学亚型中从 49.1%到 100%不等。鉴于 IVC 和 VIN3 病例中 HPV 的高流行率，预防性疫苗有可能降低外阴肿瘤的发病率。
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