日本女性 HPV 从感染到宫颈癌的基因型流行率和年龄分布：系统评价和荟萃分析。

Genotype prevalence and age distribution of human papillomavirus from infection to cervical cancer in Japanese women: A systematic review and meta-analysis.

机构信息

Melbourne School of Population and Global Health, The University of Melbourne, Melbourne Australia; Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Tokyo, Japan.

Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Tokyo, Japan.

出版信息

Vaccine. 2022 Sep 29;40(41):5971-5996. doi: 10.1016/j.vaccine.2022.07.052. Epub 2022 Sep 6.

DOI:10.1016/j.vaccine.2022.07.052

PMID:36085257

Abstract

BACKGROUND

National HPV vaccination coverage in Japan is less than one percent of the eligible population and cervical cancer incidence and mortality are increasing. This systematic review and meta-analysis aimed to provide a comprehensive estimate of HPV genotype prevalence for Japan.

METHODS

English and Japanese databases were searched to March 2021 for research reporting HPV genotypes in cytology and histology samples from Japanese women. Summary estimates were calculated by disease stage from cytology only assessment - Normal, ASCUS, LSIL, HSIL and from histological assessment - CIN1, CIN2, CIN3/AIS, ICC (ICC-SCC, and ICC-ADC), and other. A random-effects meta-analysis was used to calculate summary prevalence estimates of any-HPV, high-risk (HR) and low-risk (LR) vaccine types, and vaccine genotypes (bivalent, quadrivalent, or nonavalent). This study was registered with PROSPERO: CRD42018117596.

RESULTS

A total of 57759 women with normal cytology, 1766 ASCUS, 3764 LSIL, 2017 HSIL, 3130 CIN1, 1219 CIN2, 869 CIN3/AIS, and 4306 ICC (which included 1032 ICC-SCC, and 638 ICC-ADC) were tested for HPV. The summary estimate of any-HPV genotype in women with normal cytology was 15·6% (95% CI: 12·3-19·4) and in invasive cervical cancer (ICC) was 85·6% (80·7-89·8). The prevalence of HR-HPV was 86·0% (95% CI: 73·9-94·9) for cytological cases of HSIL, 76·9% (52·1-94·7) for histological cases of CIN3/AIS, and 75·7% (68·0-82·6) for ICC. In women with ICC, the summary prevalence of bivalent vaccine genotypes was 58·5% (95% CI: 52·1-64·9), for quadrivalent genotypes was 58·6% (52·2-64·9) and for nonavalent genotypes was 71·5% (64·9-77·6), and of ICC cases that were HPV positive over 90% of infections are nonavalent vaccine preventable. There was considerable heterogeneity in all HPV summary estimates and for ICC, this heterogeneity was not explained by variability in study design, sample type, HPV assay type, or HPV DNA detection method, although studies published in the 1990s had lower prevalence estimates of any-HPV and HR HPV genotypes.

INTERPRETATIONS

HPV prevalence is high among Japanese women. The nonavalent vaccine is likely to have the greatest impact on reducing cervical cancer incidence and mortality in Japan.

摘要

背景

日本全国 HPV 疫苗接种覆盖率不足合格人群的 1%，而宫颈癌的发病率和死亡率却在上升。本系统评价和荟萃分析旨在为日本 HPV 基因型的流行情况提供全面的评估。

方法

从 2021 年 3 月起，在英文和日文数据库中检索了报道日本女性细胞学和组织学样本中 HPV 基因型的研究。仅根据细胞学评估（正常、ASCUS、LSIL、HSIL）和组织学评估（CIN1、CIN2、CIN3/AIS、ICC（ICC-SCC 和 ICC-ADC）），计算了不同疾病阶段 HPV 基因型的汇总估计值。采用随机效应荟萃分析计算了所有 HPV、高危型（HR）和低危型（LR）疫苗型和疫苗基因型（二价、四价和九价）的汇总流行率估计值。本研究已在 PROSPERO 注册：CRD42018117596。

结果

共有 57759 名细胞学正常、1766 名 ASCUS、3764 名 LSIL、2017 名 HSIL、3130 名 CIN1、1219 名 CIN2、869 名 CIN3/AIS 和 4306 名 ICC（包括 1032 名 ICC-SCC 和 638 名 ICC-ADC）的女性接受了 HPV 检测。细胞学 HSIL 中任何 HPV 基因型的汇总估计值为 15.6%（95%CI：12.3-19.4），在侵袭性宫颈癌（ICC）中为 85.6%（80.7-89.8）。HR-HPV 在 HSIL 细胞学病例中的流行率为 86.0%（95%CI：73.9-94.9），在 CIN3/AIS 组织学病例中为 76.9%（52.1-94.7），在 ICC 中为 75.7%（68.0-82.6）。在 ICC 女性中，二价疫苗基因型的汇总流行率为 58.5%（95%CI：52.1-64.9），四价疫苗基因型为 58.6%（52.2-64.9），九价疫苗基因型为 71.5%（64.9-77.6），超过 90%的 HPV 阳性 ICC 病例都可以通过九价疫苗预防。所有 HPV 汇总估计值和 ICC 都存在很大的异质性，尽管 90 年代发表的研究报告了任何 HPV 和 HR HPV 基因型的较低流行率估计值，但研究设计、样本类型、HPV 检测方法和 HPV DNA 检测方法的变异性并不能解释 ICC 中的这种异质性。