Xu Huihui, Lin Aifen, Shao Xiujuan, Shi Weiwu, Zhang Yang, Yan Weihua
Medical Research Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China.
Human Tissue Bank, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China.
Oncotarget. 2016 Dec 13;7(50):83775-83783. doi: 10.18632/oncotarget.11959.
Currently, clinical data for primary HPV screening alone are lacking in China. Here, we evaluate cervical cancer screening with primary HPV genotyping, as well as possible future screening strategy. Overall, high-risk HPV (hrHPV) prevalence was 18.2% among hospital-based population in Taizhou area. For cervical intraepithelial neoplasia 2 or worse (CIN2+), the sensitivity of primary hrHPV genotyping strategy and current cervical cancer screening strategy were 93.5%, and 71.1%, respectively; whereas the specificity was 17.5%, and 62.4%, respectively. Current cervical screening strategy had slightly higher positive predictive values (28.4%) for CIN2+ than hrHPV genotyping strategy (21.9%), whereas primary hrHPV genotyping strategy demonstrated higher negative predictive values (94.7%) than current cervical screening strategy (91.1%). Compared to HPV35/39/45/51/56/59/66/68 genotypes, the odds ratios (OR) for CIN2+ in HPV16/18/31/33/52/58 infection women were 3.2 (95% confidence interval [CI] 2.3-4.1). Primary hrHPV genotyping strategy provides a better predictive value than HPV16/18 genotyping alone in guiding the clinical management of the current cervical cancer screening. HPV testing without adjunctive cytology may be sufficiently sensitive for primary cervical cancer screening.
目前，中国缺乏仅进行原发性人乳头瘤病毒（HPV）筛查的临床数据。在此，我们评估原发性HPV基因分型用于宫颈癌筛查的情况以及未来可能的筛查策略。总体而言，泰州地区医院人群中高危型HPV（hrHPV）的流行率为18.2%。对于宫颈上皮内瘤变2级或更严重病变（CIN2+），原发性hrHPV基因分型策略和当前宫颈癌筛查策略的敏感性分别为93.5%和71.1%；而特异性分别为17.5%和62.4%。当前宫颈癌筛查策略对CIN2+的阳性预测值（28.4%）略高于hrHPV基因分型策略（21.9%），而原发性hrHPV基因分型策略的阴性预测值（94.7%）高于当前宫颈癌筛查策略（91.1%）。与HPV35/39/45/51/56/59/66/68基因型相比，HPV16/18/31/33/52/58感染女性发生CIN2+的优势比（OR）为3.2（95%置信区间[CI] 2.3 - 4.1）。在指导当前宫颈癌筛查的临床管理方面，原发性hrHPV基因分型策略比单独的HPV16/18基因分型具有更好的预测价值。无辅助细胞学检查的HPV检测对于原发性宫颈癌筛查可能具有足够的敏感性。
