Yu Miao Crystal, Austin R Marshall, Lin Jeff, Beck Tiffany, Beriwal Sushil, Comerci John T, Edwards Robert P, Sukumvanich Paniti, Kelley Joseph, Olawaiye Alexander B
From the Departments of Gynecology Oncology (Drs Yu, Lin, Comerci, Edwards, Sukumvanich, Kelley, and Olawaiye), Pathology (Dr Austin), and Radiation Oncology (Dr Beriwal), Magee-Women's Hospital, Pittsburgh, Pennsylvania; and the Department of Gynecology Oncology, University of Washington, Seattle (Dr Beck).
Arch Pathol Lab Med. 2015 Nov;139(11):1437-40. doi: 10.5858/arpa.2014-0534-OA.
Cervical cancer affects 12 000 women in the United States annually. However, despite its prevalence, there remains no good methodology to detect its recurrence.
To identify the role of cervicovaginal high-risk human papilloma virus (hr-HPV) testing in predicting cervical cancer recurrence.
This is a retrospective study of patients who underwent hr-HPV testing as part of their routine surveillance for cervical cancer. Standard statistical analyses, including χ² test and multivariable logistic regression, were performed with IBM SPSS 19.0.
A total of 133 patients were identified, of whom 107 (80%) had squamous cell carcinoma. Ninety patients (68%) had bulky disease and were treated primarily with chemoradiation and brachytherapy. Of patients whose disease recurred, 5 patients (42%) had tested positive for hr-HPV during their surveillance period, compared to 13 patients (11%) for whom disease did not recur (relative risk: 3.88, P = .002). On multivariate logistic regression, hr-HPV status remained significantly predictive of disease recurrence (odds ratio: 12.3, P = .02, 95% confidence interval: 1.5-99.6). Using 2 × 2 table analysis, we found that while cervicovaginal cytology has limited specificity (5.7%) in predicting recurrence, the combination of cytology with hr-HPV testing increases the specificity of testing to 89.3%.
Persistence of hr-HPV is a risk factor for disease recurrence. High-risk-HPV testing is not routinely used during surveillance for cervical cancer, but this study suggests that large, prospective trials investigating the role of hr-HPV testing in cervical cancer surveillance are needed.
在美国，每年有12000名女性受到宫颈癌的影响。然而，尽管其发病率较高，但仍没有很好的方法来检测其复发情况。
确定宫颈阴道高危型人乳头瘤病毒（hr-HPV）检测在预测宫颈癌复发中的作用。
这是一项对作为宫颈癌常规监测一部分而接受hr-HPV检测的患者进行的回顾性研究。使用IBM SPSS 19.0进行标准统计分析，包括χ²检验和多变量逻辑回归。
共纳入133例患者，其中107例（80%）为鳞状细胞癌。90例（68%）患者有大块肿瘤，主要接受了放化疗和近距离放疗。在疾病复发的患者中，5例（42%）在监测期间hr-HPV检测呈阳性，而疾病未复发的患者中有13例（11%）呈阳性（相对风险：3.88，P = 0.002）。在多变量逻辑回归分析中，hr-HPV状态仍然是疾病复发的显著预测因素（优势比：12.3，P = 0.02，95%置信区间：1.5 - 99.6）。通过2×2表格分析，我们发现虽然宫颈阴道细胞学在预测复发方面特异性有限（5.7%），但细胞学与hr-HPV检测相结合可将检测特异性提高到89.3%。
hr-HPV持续存在是疾病复发的一个危险因素。高危型HPV检测在宫颈癌监测中未被常规使用，但本研究表明需要进行大规模的前瞻性试验来研究hr-HPV检测在宫颈癌监测中的作用。
