宫颈筛查与宫颈浸润性腺鳞癌及罕见组织学类型的风险：基于人群的巢式病例对照研究。
Cervical screening and risk of adenosquamous and rare histological types of invasive cervical carcinoma: population based nested case-control study.
机构信息
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden.
Center for Research and Development, Uppsala University/Region of Gävleborg, 801 88 Gävle, Sweden.
出版信息
BMJ. 2019 Apr 3;365:l1207. doi: 10.1136/bmj.l1207.
OBJECTIVES
To examine the association of cervical cytology screening with the risk of adenosquamous cell carcinoma (ASC) and rare histological types of invasive cervical carcinoma (RICC), using comprehensive registry data, and to assess tumour human papillomavirus status of ASC and RICC.
DESIGN
Nationwide, population based, nested case-control study.
SETTING
Sweden.
PARTICIPANTS
All cases of invasive cervical carcinoma in Sweden during 2002-11 (4254 confirmed cases after clinical and histopathological review). 338 cases were neither squamous cell carcinoma nor adenocarcinoma, including 164 cases of ASC and 174 cases of RICC (glassy cell carcinoma, clear cell carcinoma, small cell carcinoma, neuroendocrine cell carcinoma, large cell carcinoma, and undifferentiated carcinoma). 30 birth year matched controls from the general Swedish population were matched to each case by applying incidence density sampling.
MAIN OUTCOME MEASURES
Conditional logistic regression was used to calculate odds ratios, interpreted as incidence rate ratios, for risk of ASC and RICC in relation to screening status and screening history, adjusted for education. Human papillomavirus distribution of ASC and RICC was based on available archival tumour tissues from most Swedish pathology biobanks.
RESULTS
Women with two screening tests in the previous two recommended screening intervals had a lower risk of ASC (incidence rate ratio 0.22, 95% confidence interval 0.14 to 0.34) and RICC (0.34, 0.21 to 0.55), compared with women without any test. High risk human papillomavirus was detected in 148/211 (70%) cases with valid human papillomavirus results from tumour tissues. The risk reduction among women with tumours that were positive (incidence rate ratio 0.28, 0.18 to 0.46) and negative (0.27, 0.13 to 0.59) for high risk human papillomavirus was similar, compared with women who did not attend any test.
CONCLUSIONS
Cervical screening is associated with reduced risk of ASC and RICC, and most ASC and RICC are positive for high risk human papillomavirus. This evidence provides a benchmark for evaluating future cervical screening strategies.
目的
利用综合登记数据，研究宫颈细胞学筛查与宫颈腺鳞癌（ASC）和罕见浸润性宫颈癌（RICC）风险的关系，并评估 ASC 和 RICC 的肿瘤人乳头瘤病毒（HPV）状况。
设计
全国范围内，基于人群的巢式病例对照研究。
地点
瑞典。
参与者
2002-11 年期间瑞典所有浸润性宫颈癌病例（临床和组织病理学复查后确诊 4254 例）。338 例既非鳞状细胞癌也非腺癌，包括 164 例 ASC 和 174 例 RICC（玻璃样细胞癌、透明细胞癌、小细胞癌、神经内分泌细胞癌、大细胞癌和未分化癌）。根据发病率密度抽样，为每个病例匹配了 30 名来自一般瑞典人群的出生年份匹配对照。
主要观察指标
采用条件逻辑回归计算 ASC 和 RICC 风险与筛查状况和筛查史的比值比（解释为发病率比），调整教育因素。ASC 和 RICC 的 HPV 分布基于大多数瑞典病理生物库中可用的存档肿瘤组织。
结果
与没有任何检查的女性相比，在前两个推荐筛查间隔内进行两次筛查的女性 ASC（发病率比 0.22，95%置信区间 0.14 至 0.34）和 RICC（0.34，0.21 至 0.55）的风险降低。211 例有肿瘤组织有效 HPV 结果的病例中，有 148 例（70%）检测到高危 HPV。高危 HPV 阳性（发病率比 0.28，0.18 至 0.46）和阴性（0.27，0.13 至 0.59）肿瘤女性的风险降低与未接受任何检查的女性相似。
结论
宫颈筛查与 ASC 和 RICC 风险降低相关，大多数 ASC 和 RICC 均为高危 HPV 阳性。该证据为评估未来的宫颈筛查策略提供了基准。
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