Zhu Haiyan, Shen Zhaojun, Luo Hui, Zhang Wenwen, Zhu Xueqiong
From the Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Medicine (Baltimore). 2016 Mar;95(13):e3077. doi: 10.1097/MD.0000000000003077.
As whether Chlamydia trachomatis infection increases the risk of cervical cancer is controversial in the literature, we performed a meta-analysis.Based on a comprehensive search of publications in the Medline, Cochrane, and EMBASE databases, we identified and extracted data from all relevant articles examining C. trachomatis infection and the risk of cervical cancer. The quality of each included study was assessed according to the 9-star Newcastle-Ottawa scale. The strength of association between the C. trachomatis and risk of cervical cancer was estimated by odds ratio (OR) and 95% confidence intervals (CIs). This review was registered at PROSPERO with registration No. CRD42014015672. A total of 22 studies with 4291 cervical cancer cases and 7628 controls were identified. Overall, C. trachomatis was significantly linked to increased cervical cancer risk in prospective studies (OR = 2.21, 95% CI: 1.88-2.61, P < 0.001), as well as in retrospective studies (OR = 2.19, 95% CI: 1.74-2.74, P < 0.001). Additionally, with a multivariate logistic regression analysis adjusted for HPV and age, C. trachomatis infection was identified as an independent predictor of cervical cancer in 11 studies (OR = 1.76, 95% CI: 1.03-3.01, P = 0.04). Coinfection of human papilloma virus and C. trachomatis has a higher risk of cervical cancer (OR = 4.03, 95% CI: 3.15-5.16, P < 0.001). A subgroup analysis based on histological type indicated an elevated risk for both squamous cell carcinoma (OR = 2.21, 95% CI: 2.00-2.45, P < 0.001), and adenocarcinoma (OR = 1.61, 95% CI: 1.21-2.15, P = 0.001), in associated with C. trachomatis. Subgroup analysis by where C. trachomatis infection was detected showed a significantly higher risk of cervical cancer associated with C. trachomatis infection detected in serum (OR = 2.20, 95% CI: 2.01-2.42, P < 0.001), cervical tissue blocks (OR = 2.88, 95% CI: 1.21-6.83, P = 0.02), and cervical secretion (OR = 2.71, 95% CI: 1.41-5.20, P = 0.003), especially in serum with no obvious heterogeneity.In conclusion, our novel data demonstrate that individuals infected with C. trachomatis have a higher risk of cervical cancer. Therefore, it is necessary to expand C. trachomatis infection screening and treat women with C. trachomatis promptly, particularly those with human papilloma virus infections. This approach will not only protect against pelvic inflammatory disease and infertility, but may also prevent cervical cancer.
由于沙眼衣原体感染是否会增加宫颈癌风险在文献中存在争议,我们进行了一项荟萃分析。通过全面检索Medline、Cochrane和EMBASE数据库中的出版物,我们识别并从所有研究沙眼衣原体感染与宫颈癌风险的相关文章中提取了数据。根据9星纽卡斯尔-渥太华量表评估每项纳入研究的质量。沙眼衣原体与宫颈癌风险之间的关联强度通过比值比(OR)和95%置信区间(CI)进行估计。本综述已在PROSPERO注册,注册号为CRD42014015672。共识别出22项研究,其中包括4291例宫颈癌病例和7628例对照。总体而言,在前瞻性研究中(OR = 2.21,95% CI:1.88 - 2.61,P < 0.001)以及回顾性研究中(OR = 2.19,95% CI:1.74 - 2.74,P < 0.001),沙眼衣原体均与宫颈癌风险增加显著相关。此外,在11项研究中,经过对人乳头瘤病毒(HPV)和年龄进行多因素逻辑回归分析调整后,沙眼衣原体感染被确定为宫颈癌的独立预测因素(OR = 1.76,95% CI:1.03 - 3.01,P = 0.04)。人乳头瘤病毒与沙眼衣原体的合并感染具有更高的宫颈癌风险(OR = 4.03,95% CI:3.15 - 5.16,P < 0.001)。基于组织学类型的亚组分析表明,鳞状细胞癌(OR = 2.21,95% CI:2.00 - 2.45,P < 0.001)和腺癌(OR = 1.61,95% CI:1.21 - 2.15,P = 0.001)与沙眼衣原体感染相关的风险均有所升高。根据沙眼衣原体感染检测部位进行的亚组分析显示,在血清(OR = 2.20,95% CI:2.01 - 2.42,P < 0.001)、宫颈组织块(OR = 2.88,95% CI:1.21 - 6.83,P = 0.02)和宫颈分泌物(OR = 2.71,95% CI:1.41 - 5.20,P = 0.003)中检测到沙眼衣原体感染与宫颈癌风险显著升高相关,尤其是在血清中且无明显异质性。总之,我们的新数据表明,感染沙眼衣原体的个体患宫颈癌的风险更高。因此,有必要扩大沙眼衣原体感染筛查,并及时治疗沙眼衣原体感染的女性,特别是那些感染人乳头瘤病毒的女性。这种方法不仅可以预防盆腔炎和不孕症,还可能预防宫颈癌。