Tantitamit Tanitra, Termrungruanglert Wichai, Khemapech Nipon, Havanond Piyalamporn
Department of Obstetrics and Gynecology, Faculty of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC), Srinakharinwirot University, Nakornnayok, Thailand. Email:
Asian Pac J Cancer Prev. 2017 May 1;18(5):1271-1275. doi: 10.22034/APJCP.2017.18.5.1271.
Objective: The aim of this study was to compare the efficacy of HPV 16/18 genotyping test, high risk HPV DNA testing, alone and in conjunction with the liquid-based cytology method in screening for cervical cancer precursors. Methods: A Markov model was used to describe the course of the cases of CIN2+ that had been detected over a 35 year period. Screening programs started at age 30 and were performed at an interval of once every five years. The model compared three strategies of HPV 16/18 genotyping with reflex cytology triage, high-risk HPV testing alone with referral to colposcopy and cytology-based screening with referral to colposcopy. We assumed the rate of patients lost to follow-up for those referred to colposcopy would be 0%. The clinical parameters were estimated using the data from a study conducted by the Thailand National Cancer Institute. Result: Of the three screening strategies evaluated, the high risk HPV DNA testing alone was the most effective for detecting CIN2+ over the 35 year study period. It detected 143 and 510 cases per 100,000 women more than the HPV 16/18 genotyping test and cytology-based strategy, respectively. The HPV genotyping test detected 368 cases per 100,000 women more than the cytology-based approach. In addition, when viewed with five year intervals, there were missed cases totaling approximately half of the detected cases screened by the cytology strategy and 10% of cases detected with screening by the HPV genotyping test. Conclusion: This study strongly indicates that HPV/DNA testing is preferable to cytology-based screening for cervical cancer precursors. However, the balance between the benefits, burdens and cost of each screening program should be considered.
本研究旨在比较人乳头瘤病毒16/18基因分型检测、高危型人乳头瘤病毒DNA检测单独使用以及与液基细胞学方法联合使用在筛查宫颈癌前病变中的效果。方法：采用马尔可夫模型描述在35年期间检测到的CIN2+病例的病程。筛查项目从30岁开始，每五年进行一次。该模型比较了三种策略：人乳头瘤病毒16/18基因分型联合细胞学分流、单独进行高危型人乳头瘤病毒检测并转诊至阴道镜检查以及基于细胞学的筛查并转诊至阴道镜检查。我们假设转诊至阴道镜检查的患者失访率为0%。临床参数使用泰国国家癌症研究所进行的一项研究的数据进行估计。结果：在评估的三种筛查策略中，单独进行高危型人乳头瘤病毒DNA检测在35年的研究期间检测CIN2+最为有效。与分别与人乳头瘤病毒16/18基因分型检测和基于细胞学的策略相比，每10万名女性中它多检测出143例和510例病例。人乳头瘤病毒基因分型检测比基于细胞学的方法每10万名女性多检测出368例病例。此外，以五年为间隔来看，基于细胞学策略筛查出的病例中约有一半以及人乳头瘤病毒基因分型检测筛查出的病例中有10%被漏诊。结论：本研究有力地表明，对于宫颈癌前病变，人乳头瘤病毒/DNA检测优于基于细胞学的筛查。然而，应考虑每个筛查项目的益处、负担和成本之间的平衡。
