Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Biol Blood Marrow Transplant. 2018 May;24(5):1094-1098. doi: 10.1016/j.bbmt.2018.01.019. Epub 2018 Feb 9.
Annual cervical cancer screening with Papanicolaou (Pap) and human papillomavirus (HPV) testing after stem cell transplant (SCT) is recommended, but the uptake is unknown. We aimed to determine the prevalence and predictors of cervical cancer screening in patients with hematologic malignancies. We searched MarketScan Commercial Claims database for women who underwent allogeneic or autologous SCT. The primary outcome was cervical cancer screening, defined as procedures or abnormal results for HPV and/or Pap testing according administrative codes within 2 years after SCT. A multivariable logistic regression model was fitted with cancer type, SCT year, age, geographic area, insurance plan, comorbidity, and presence of graft-versus-host disease (GVHD).The study included 1484 patients; 1048 patients (70.6%) had autologous and 436 (29.4%) allogeneic SCT. Mean age was 52.5 years. Overall, 660 patients (44.5%) had screening within 2 years after SCT, 214 (49.1%) with allogeneic SCT and 446 (42.6%) with autologous SCT (P = .02). In the allogeneic SCT group, patients with GVHD had a lower rate of screening than patients without GVHD (42.5% versus 55.4%, P < .01), and GVHD was associated with lower odds of screening (odds ratio, .50; 95% confidence interval, .32 to .79). In the autologous SCT group, patients with comorbid medical conditions had a lower rate of screening than patients without comorbidity (36.0% versus 45.7%, P < .01). In both allogeneic and autologous SCT groups older patients had lower odds of screening. Cervical cancer screening rates after SCT are low, particularly in patients with GVHD, who are at significant risk of second malignancies. Future work is needed to develop strategies to increase uptake.
建议对接受过干细胞移植（SCT）的患者进行年度宫颈癌筛查，包括巴氏涂片（Pap）和人乳头瘤病毒（HPV）检测，但目前尚不清楚这种筛查的接受程度。我们旨在确定血液系统恶性肿瘤患者的宫颈癌筛查的流行率和预测因素。我们在 MarketScan 商业索赔数据库中搜索了接受过同种异体或自体 SCT 的女性。主要结局是宫颈癌筛查，根据行政代码定义为 SCT 后 2 年内进行的 HPV 和/或 Pap 检测程序或异常结果。使用多变量逻辑回归模型，根据癌症类型、SCT 年份、年龄、地理区域、保险计划、合并症和移植物抗宿主病（GVHD）的存在情况进行拟合。该研究纳入了 1484 例患者；1048 例（70.6%）患者接受了自体 SCT，436 例（29.4%）患者接受了同种异体 SCT。平均年龄为 52.5 岁。总体而言，660 例（44.5%）患者在 SCT 后 2 年内进行了筛查，其中 214 例（49.1%）接受了同种异体 SCT，446 例（42.6%）接受了自体 SCT（P=0.02）。在同种异体 SCT 组中，患有 GVHD 的患者筛查率低于未患有 GVHD 的患者（42.5%比 55.4%，P<0.01），GVHD 与较低的筛查可能性相关（比值比，0.50；95%置信区间，0.32 至 0.79）。在自体 SCT 组中，患有合并症的患者筛查率低于无合并症的患者（36.0%比 45.7%，P<0.01）。在同种异体和自体 SCT 组中，年龄较大的患者筛查可能性较低。SCT 后宫颈癌筛查率较低，尤其是患有 GVHD 的患者，他们存在严重的第二恶性肿瘤风险。需要进一步研究制定提高接受率的策略。
