Department of Surgical Sciences University of Torino, Via Ventimiglia 3, 10126, Torino, Italy.
Piedmont Cancer Registry - CPO, Torino, Italy.
BMC Cancer. 2020 Oct 7;20(1):972. doi: 10.1186/s12885-020-07452-6.
The aim was to estimate the risk of subsequent extra-cervical Human Papillomavirus (HPV) related cancer in patients surgically treated for high grade cervical intraepithelial neoplasia (CIN 2-3). This is the first study in Italy investigating the occurrence of extra-cervical tumors in this cohort of patients.
3184 patients surgically treated for CIN2-3 since 1992 at the Department of Surgical Sciences of University of Torino were considered. The risk of HPV-related cancer was calculated as Standardized Incidence Ratio (SIR), using as expected values tumour age specific incidence of resident population.
173 second primary cancer (SCPs) were identified. SIR to develop cancer after treatment for CIN2-3 was 2.2 (CI 95% 1.89-2.50). Among these occurrences, 10 are in HPV related sites: 1 anus (SIR = 1.8; 0.04-10.0), 3 vagina (SIR = 12.4; 2.56-36.3), 1 vulva (SIR = 1.7; 0.04-9.59), 5 oropharynx (SIR = 8.5; 2.76-19.8). Significant risk has been also recorded for pulmonary (SIR = 3.1; 0.70-5.27) and bladder (SIR = 4.05; 1.10-10.56), with smoking as possible cofactor. We also found increased risk for breast (SIR = 2.4; 2.07-2.84) and ovarian cancers (SIR = 2.1; 1.13-3.49), probably due to an higher adherence to spontaneous and programmed screening programs.
Our study supports the hypothesis of an increased risk of HPV-related tumours for CIN treated patients, mostly for CIN3. It is conceivable the need of early diagnosis for these cancers in this higher-risk populations.
本研究旨在评估因高级别宫颈上皮内瘤变（CIN2-3）接受手术治疗的患者随后发生宫颈外 HPV 相关癌症的风险。这是意大利首次针对该队列患者中宫颈外肿瘤发生情况进行的研究。
共纳入 1992 年以来在都灵大学外科科学系接受 CIN2-3 手术治疗的 3184 例患者。使用居民人口肿瘤年龄特异性发病率作为预期值，计算 HPV 相关癌症的风险比（标准化发病率比[SIR]）。
共发现 173 例第二原发癌（SCP）。CIN2-3 治疗后发生癌症的 SIR 为 2.2（95%CI：1.89-2.50）。在这些病例中，10 例为 HPV 相关部位：1 例肛门（SIR=1.8；0.04-10.0），3 例阴道（SIR=12.4；2.56-36.3），1 例外阴（SIR=1.7；0.04-9.59），5 例口咽（SIR=8.5；2.76-19.8）。肺（SIR=3.1；0.70-5.27）和膀胱（SIR=4.05；1.10-10.56）也存在显著风险，可能与吸烟有关。我们还发现乳腺癌（SIR=2.4；2.07-2.84）和卵巢癌（SIR=2.1；1.13-3.49）的风险增加，可能是由于这些高风险人群对自发性和计划性筛查方案的依从性更高。
本研究支持 CIN 治疗患者存在 HPV 相关肿瘤风险增加的假设，尤其是 CIN3 患者。对于这些高危人群，可能需要早期诊断这些癌症。
