Fu Yunfeng, Li Ying, Li Xiao, Wang Xinyu, Lü Weiguo
Medical Centre for Cervical Diseases, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
J Med Virol. 2023 Feb;95(2):e28482. doi: 10.1002/jmv.28482.
To evaluate the effect of DH3-human papillomavirus (HPV) partial genotyping for risk stratification in cervical cancer screening, we conducted a post hoc analysis within a retrospective cohort of 7263 Chinese women aged 21-71 years who participated in population-based screening. The residual cytological samples at baseline were retested with DH3-HPV and Hybrid Capture 2 (HC2) assay after 3-year follow-up. Risk values with 95% confidence intervals (CIs) of cervical intraepithelial neoplasia (CIN) grade 3/2 or worse (CIN3+/CIN2+) were estimated based on HPV and cytology results. The report complies with the STROBE statement. Across every cytological result, risk estimates obtained from DH3-HPV and HC2 were similar or almost identical. By DH3-HPV partial genotyping, risks of CIN3+/CIN2+ were invariably higher for HPV16/18 than other high-risk HPV (hrHPV). Among women with normal cytology, immediate CIN3+ risks were 8.16% (95% CI = 4.19%-15.28%) for HPV16/18 positive and 0.48% (95% CI = 0.13%-1.73%) for other hrHPV positive. Among women with any abnormal cytology, immediate CIN3+ risks were 33.33% (95% CI = 22.24%-46.64%) for HPV16/18, and 13.33% (95% CI = 8.37%-20.56%) for other hrHPV. Among 5840 women completed 3-year follow-up, the cumulative CIN3+ risk was 25.56% (95% CI = 18.91%-33.59%) for HPV16/18 and 8.22% (95% CI = 6.02%-11.13%) for other hrHPV. Women with an HPV-negative result with DH3-HPV or HC2 test had very low cumulative 3-year CIN3+ risk (0.06%, 95% CI = 0.02%-0.17%), which was about one-tenth of women with normal cytology at baseline (0.62%, 95% CI = 0.45%-0.86%). Similar patterns were observed for the endpoint of CIN2+. These findings suggest that partial genotyping of DH3-HPV performs well in risk stratification, which can better balance the benefits and harms of cervical cancer screening.
为评估DH3人乳头瘤病毒（HPV）部分基因分型在宫颈癌筛查风险分层中的作用，我们在一项回顾性队列研究中进行了事后分析，该队列研究纳入了7263名年龄在21至71岁之间参与基于人群筛查的中国女性。在3年随访后，对基线时留存的细胞学样本采用DH3-HPV和第二代杂交捕获法（HC2）进行重新检测。基于HPV和细胞学检查结果，估算宫颈上皮内瘤变（CIN）3/2级及以上（CIN3+/CIN2+）的风险值及其95%置信区间（CI）。本报告符合加强流行病学观察性研究报告规范（STROBE）声明。在每一种细胞学检查结果中，DH3-HPV和HC2获得的风险估计值相似或几乎相同。通过DH3-HPV部分基因分型，HPV16/18型导致CIN3+/CIN2+的风险始终高于其他高危HPV（hrHPV）。在细胞学检查正常的女性中，HPV16/18阳性者CIN3+的即刻风险为8.16%（95%CI=4.19%-15.28%），其他hrHPV阳性者为0.48%（95%CI=0.13%-1.73%）。在任何细胞学检查异常的女性中，HPV16/18型CIN3+的即刻风险为33.33%（95%CI=22.24%-46.64%），其他hrHPV为13.33%（95%CI=8.37%-20.56%）。在完成3年随访的5840名女性中，HPV16/18型CIN3+的累积风险为25.56%（95%CI=18.91%-33.59%），其他hrHPV为8.22%（95%CI=6.02%-11.13%）。DH3-HPV或HC2检测HPV结果为阴性的女性，其3年CIN3+的累积风险非常低（0.06%，95%CI=0.02%-0.17%），约为基线细胞学检查正常女性（0.62%，95%CI=0.45%-0.86%）的十分之一。对于CIN2+这一终点，也观察到了类似模式。这些发现表明，DH3-HPV部分基因分型在风险分层方面表现良好，能够更好地平衡宫颈癌筛查的利弊。
