Andersson Sonia, Mints Miriam, Wilander Erik
Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska University Hospital-Solna, The Karolinska Institute, Stockholm S-171 76;
Oncol Lett. 2013 Jul;6(1):215-219. doi: 10.3892/ol.2013.1350. Epub 2013 May 15.
The incidence rates of cervical adenocarcinoma have been increasing over the last two decades, contrary to those of squamous cell carcinoma. This trend is particularly evident among females aged <40 years and has occurred despite extensive cytology-based screening programs. The aim of the present retrospective database study was to investigate adenocarcinoma (AIS) with respect to previous cytological results, high-risk (HR) human papillomavirus (HPV) infections and histological results from AIS-adjacent squamous mucosa. Databases were used to identify 32 female patients with AIS treated for various conditions between 2009 and 2012 at the Department of Gynecology, Uppsala University Hospital (Uppsala, Sweden) and previous cytological, HPV and histological results. Of the individuals in the study, 64.3% had a previously recorded cytological result showing squamous cell abnormalities; five had glandular cell abnormalities (18%) and two had AIS (7.1%). Among the patients with available HPV results, 95% were HR-HPV-positive; HPV18/45 predominated (77%), followed by HPV16 (27%). The patients with multiple HPV infections were aged ≤32 years, while patients aged ≥38 years were only infected with HPV18/45. All but three patients had cervical intraepithelial neoplasia (CIN) in the AIS-adjacent squamous mucosa, 79% of which was CIN2 or worse. The present retrospective database study suggests that AIS is detected at screening mainly due to simultaneous squamous precursor lesions and that HPV18/45 infection is an increasing cofactor for AIS in older patients. HPV analyses of glandular precursor lesions aid in the identification of female individuals at risk of progression to invasive disease, and thus have a favorable effect on adenocarcinoma prevention, together with vaccination.
在过去二十年中，宫颈腺癌的发病率一直在上升，这与鳞状细胞癌的发病率趋势相反。这种趋势在40岁以下的女性中尤为明显，尽管有广泛的基于细胞学的筛查项目，但仍出现了这种情况。本回顾性数据库研究的目的是调查宫颈原位腺癌（AIS）与先前细胞学结果、高危（HR）人乳头瘤病毒（HPV）感染以及AIS相邻鳞状黏膜组织学结果之间的关系。利用数据库识别了2009年至2012年期间在瑞典乌普萨拉大学医院妇科因各种病症接受治疗的32例AIS女性患者以及先前的细胞学、HPV和组织学结果。在研究对象中，64.3%曾有细胞学结果显示鳞状细胞异常；5例有腺细胞异常（18%），2例有AIS（7.1%）。在有可用HPV结果的患者中，95%为HR-HPV阳性；HPV18/45占主导（77%），其次是HPV16（27%）。多重HPV感染的患者年龄≤32岁，而年龄≥38岁的患者仅感染HPV18/45。除3例患者外，所有患者在AIS相邻的鳞状黏膜中都有宫颈上皮内瘤变（CIN），其中79%为CIN2或更严重病变。本回顾性数据库研究表明，AIS在筛查时主要是由于同时存在鳞状前驱病变而被发现，并且HPV18/45感染在老年患者中是AIS日益增加的辅助因素。对腺前驱病变进行HPV分析有助于识别有进展为浸润性疾病风险的女性个体，因此与疫苗接种一起对腺癌预防有积极作用。
