Ogilvie Gina S, Krajden Mel, van Niekerk Dirk, Smith Laurie W, Cook Darrel, Ceballos Kathy, Lee Marette, Gentile Laura, Gondara Lovedeep, Elwood-Martin Ruth, Peacock Stuart, Stuart Gavin, Franco Eduardo L, Coldman Andrew J
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
British Columbia Centre for Disease Control, Vancouver, BC, Canada.
Int J Cancer. 2017 Jan 15;140(2):440-448. doi: 10.1002/ijc.30454. Epub 2016 Oct 20.
Complete Round 1 data (baseline and 12-month follow-up) for HPV FOCAL, a randomized trial establishing the efficacy of HPV DNA testing with cytology triage as a primary screen for cervical cancer are presented. Women were randomized to one of three arms: Control arm - Baseline liquid-based cytology (LBC) with ASCUS results triaged with HPV testing; Intervention and Safety arms - Baseline HPV with LBC triage for HPV positives. Results are presented for 15,744 women allocated to the HPV (intervention and safety combined) and 9,408 to the control arms. For all age cohorts, the CIN3+ detection rate was higher in the HPV (7.5/1,000; 95%CI: 6.2, 8.9) compared to the control arm (4.6/1,000; 95%CI: 3.4, 6.2). The CIN2+ detection rates were also significantly higher in the HPV (16.5/1,000; 95%CI: 14.6, 18.6) vs. the control arm (10.1/1,000; 95%CI: 8.3, 12.4). In women ≥35 years, the overall detection rates for CIN2+ and CIN3+ were higher in the HPV vs. the control arm (CIN2+:10.0/1,000 vs. 5.2/1,000; CIN3+: 4.2/1,000 vs. 2.2/1,000 respectively, with a statistically significant difference for CIN2+). HPV testing detected significantly more CIN2+ in women 25-29 compared to LBC (63.7/1,000; 95%CI: 51.9, 78.0 vs. 32.4/1,000; 95%CI: 22.3, 46.8). HPV testing resulted in significantly higher colposcopy referral rates for all age cohorts (HPV: 58.9/1,000; 95%CI: 55.4, 62.7 vs.
30.9/1,000; 95%CI: 27.6, 34.6). At completion of Round 1 HPV-based cervical cancer screening in a population-based program resulted in greater CIN2+ detection of across all age cohorts compared to LBC screening.
本文展示了HPV FOCAL研究第一轮的完整数据(基线和12个月随访),该研究是一项随机试验,旨在确定以细胞学分流的HPV DNA检测作为宫颈癌初步筛查方法的有效性。女性被随机分为三组之一:对照组——基线液基细胞学检查(LBC),对非典型鳞状细胞(ASCUS)结果进行HPV检测分流;干预组和安全组——基线HPV检测,对HPV阳性结果进行LBC分流。呈现了分配至HPV组(干预组和安全组合并)的15744名女性和分配至对照组的9408名女性的结果。在所有年龄组中,HPV组的高级别鳞状上皮内病变(CIN3+)检出率(7.5/1000;95%置信区间:6.2,8.9)高于对照组(4.6/1000;95%置信区间:3.4,6.2)。HPV组的CIN2+检出率(16.5/1000;95%置信区间:14.6,18.6)也显著高于对照组(10.1/1000;95%置信区间:8.3,12.4)。在35岁及以上女性中,HPV组的CIN2+和CIN3+总体检出率高于对照组(CIN2+:10.0/1000对5.2/1000;CIN3+:4.2/1000对2.2/1000,CIN2+有统计学显著差异)。与LBC相比,HPV检测在25 - 29岁女性中检测出的CIN2+显著更多(63.7/1000;95%置信区间:51.9,78.0对32.4/1000;95%置信区间:22.3,46.8)。HPV检测导致所有年龄组的阴道镜转诊率显著更高(HPV组:58.9/1000;95%置信区间:55.4,62.7对对照组:30.9/1000;95%置信区间:27.6,34.6)。在一项基于人群的项目中,完成第一轮基于HPV的宫颈癌筛查后,与LBC筛查相比,在所有年龄组中CIN2+的检出率更高。