人乳头瘤病毒和细胞学联合检测若干阴性轮次对宫颈癌安全性的影响：一项观察性队列研究。
Effect of Several Negative Rounds of Human Papillomavirus and Cytology Co-testing on Safety Against Cervical Cancer: An Observational Cohort Study.
机构信息
From Albert Einstein College of Medicine, Bronx, New York; The Permanente Medical Group, Oakland, California; National Cancer Institute, Bethesda, Maryland; and Peking University, Beijing, China.
出版信息
Ann Intern Med. 2018 Jan 2;168(1):20-29. doi: 10.7326/M17-1609. Epub 2017 Nov 28.
BACKGROUND
Current U.S. cervical cancer screening and management guidelines do not consider previous screening history, because data on multiple-round human papillomavirus (HPV) and cytology "co-testing" have been unavailable.
OBJECTIVE
To measure cervical cancer risk in routine practice after successive negative screening co-tests at 3-year intervals.
DESIGN
Observational cohort study.
SETTING
Integrated health care system (Kaiser Permanente Northern California, Oakland, California).
PATIENTS
990 013 women who had 1 or more co-tests from 2003 to 2014.
MEASUREMENTS
3- and 5-year cumulative detection of (risk for) cervical intraepithelial neoplasia grade 3, adenocarcinoma in situ, and cervical cancer (≥CIN3) in women with different numbers of negative co-tests, overall and within subgroups defined by previous co-test results or baseline age.
RESULTS
Five-year ≥CIN3 risks decreased after each successive negative co-test screening round (0.098%, 0.052%, and 0.035%). Five-year ≥CIN3 risks for an HPV-negative co-test, regardless of the cytology result, nearly matched the performance (reassurance) of a negative co-test for each successive round of screening (0.114%, 0.061%, and 0.041%). By comparison, ≥CIN3 risks for the cytology-negative co-test, regardless of the HPV result, also decreased with each successive round, but 3-year risks were as high as 5-year risks after an HPV-negative co-test (0.199%, 0.065%, and 0.043%). No interval cervical cancer cases were diagnosed after the second negative co-test. Independently, ≥CIN3 risks decreased with age. Length of previous screening interval did not influence future ≥CIN3 risks.
LIMITATION
Interval-censored observational data.
CONCLUSION
After 1 or more negative cervical co-tests (or HPV tests), longer screening intervals (every 5 years or more) might be feasible and safe.
PRIMARY FUNDING SOURCE
National Cancer Institute Intramural Research Program.
背景
目前美国的宫颈癌筛查和管理指南不考虑既往的筛查史，因为多轮人乳头瘤病毒（HPV）和细胞学“联合检测”的数据不可用。
目的
测量连续阴性筛查联合检测后 3 年间隔常规实践中的宫颈癌风险。
设计
观察性队列研究。
设置
综合医疗保健系统（加利福尼亚州奥克兰的 Kaiser Permanente 北部加利福尼亚）。
患者
2003 年至 2014 年期间进行过 1 次或多次联合检测的 99013 名女性。
测量
不同阴性联合检测次数的女性 3 年和 5 年累积宫颈上皮内瘤变 3 级、原位腺癌和宫颈癌（≥CIN3）的检出率（风险），总体和根据既往联合检测结果或基线年龄定义的亚组内。
结果
每轮连续阴性联合检测后，5 年≥CIN3 风险均降低（0.098%、0.052%和 0.035%）。无论细胞学结果如何，HPV 阴性联合检测的 5 年≥CIN3 风险几乎与每轮筛查的阴性联合检测表现（保证）相匹配（0.114%、0.061%和 0.041%）。相比之下，细胞学阴性联合检测的≥CIN3 风险也随着每轮检测而降低，但 HPV 阴性联合检测后 3 年风险与 5 年风险一样高（0.199%、0.065%和 0.043%）。第二轮阴性联合检测后未诊断出间隔期宫颈癌病例。独立地，CIN3 风险随年龄降低。既往筛查间隔时间不影响未来≥CIN3 风险。
局限性
区间 censored 观察数据。
结论
在进行 1 次或多次阴性宫颈联合检测（或 HPV 检测）后，较长的筛查间隔（每 5 年或更长时间）可能是可行且安全的。
主要资金来源
美国国立癌症研究所内部研究计划。
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