Castle Philip E, Aslam Shagufta, Behrens Catherine
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
Global Coalition Against Cervical Cancer, Arlington, Virginia.
Cancer Epidemiol Biomarkers Prev. 2016 Dec;25(12):1595-1599. doi: 10.1158/1055-9965.EPI-16-0330. Epub 2016 Sep 1.
Cervical cancer risks, estimated by using cervical intraepithelial neoplasia grade 3 (CIN3) or more severe diagnoses (≥CIN3) endpoints, have not been quantified for different combinations of results from currently approved screening methods. Understanding these risks will guide optimal patient management.
Women aged ≥25 years (n = 7,823) underwent high-risk human papillomavirus (hrHPV) and liquid-based cytology (LBC) testing. Women with hrHPV-positive results and/or abnormal LBC, plus a random subset of hrHPV and LBC negatives, underwent colposcopy; those without ≥CIN2 at baseline were screened annually by LBC and referred to colposcopy for an abnormal LBC (n = 7,392). One- and 3-year ≥CIN3 risks with 95% confidence intervals (95% CI) were calculated for paired hrHPV and LBC (hrHPV/LBC) results.
One-year ≥CIN3 risks ranged from 81.27% (95% CI, 66.02%-90.65%) for HPV16 positive/high-grade to 0.33% (95% CI, 0.18%-0.62%) for hrHPV negative/negative for intraepithelial lesion or malignancy (NILM). One-year ≥CIN3 risk for HPV16/NILM (13.95%; 95% CI, 10.98%-17.58%) was greater than low-grade squamous intraepithelial lesion (LSIL; 7.90%; 95% CI, 5.99%-10.37%; P = 0.002) and similar to hrHPV-positive/LSIL (11.45%; 95% CI, 8.61%-15.07%; P = 0.3). Three-year ≥CIN3 risks for HPV16 positive/LSIL and HPV16/atypical squamous cells of undetermined significance was 24.79% (95% CI, 16.44%-35.58%) and 24.36% (95% CI, 15.86%-35.50%), respectively, and 0.72% (95% CI, 0.45%-1.14%) for hrHPV negative/NILM.
hrHPV and LBC results stratify cervical cancer risk by more than two orders of magnitude. HPV16-positive women, regardless of the LBC result, warrant immediate colposcopy. Women with concurrent HPV16 and high-grade LBC might consider treatment without a confirmatory biopsy with informed decision-making with their provider.
These results provide relevant benchmarks for risk-based cervical cancer screening and management. Cancer Epidemiol Biomarkers Prev; 25(12); 1595-9. ©2016 AACR.
采用宫颈上皮内瘤变3级（CIN3）或更严重诊断（≥CIN3）终点估算的宫颈癌风险，尚未针对目前获批的筛查方法的不同结果组合进行量化。了解这些风险将指导优化患者管理。
年龄≥25岁的女性（n = 7823）接受了高危型人乳头瘤病毒（hrHPV）和液基细胞学（LBC）检测。hrHPV检测结果呈阳性和/或LBC结果异常的女性，以及hrHPV和LBC检测结果为阴性的随机子集女性，接受了阴道镜检查；基线时无≥CIN2的女性每年接受LBC筛查，LBC结果异常时转诊至阴道镜检查（n = 7392）。针对配对的hrHPV和LBC（hrHPV/LBC）结果计算1年和3年≥CIN3风险及95%置信区间（95%CI）。
1年≥CIN3风险范围从HPV16阳性/高级别组的81.27%（95%CI，66.02% - 90.65%）到hrHPV阴性/上皮内病变或恶性肿瘤阴性（NILM）组的0.33%（95%CI，0.18% - 0.62%）。HPV16/NILM组的1年≥CIN3风险（13.95%；95%CI，10.98% - 17.58%）高于低级别鳞状上皮内病变（LSIL）组（7.90%；95%CI，5.99% - 10.37%；P = 0.002），与hrHPV阳性/LSIL组（11.45%；95%CI，8.61% - 15.07%；P = 0.3）相似。HPV16阳性/LSIL组和HPV16/意义不明确的非典型鳞状细胞组的3年≥CIN3风险分别为24.79%（95%CI，16.44% - 35.58%）和24.36%（95%CI，15.86% - 35.50%），hrHPV阴性/NILM组为0.72%（95%CI，0.45% - 1.14%）。
hrHPV和LBC结果将宫颈癌风险分层超过两个数量级。HPV16阳性的女性，无论LBC结果如何，均需立即接受阴道镜检查。同时存在HPV16和高级别LBC的女性，在与医疗服务提供者进行充分知情决策后，可考虑在无确诊活检的情况下接受治疗。
这些结果为基于风险的宫颈癌筛查和管理提供了相关基准。《癌症流行病学、生物标志物与预防》；25(12)；1595 - 9。©2016美国癌症研究协会。
