Center for Cervical Cancer Elimination, Department of Clinical Pathology and Cancer Diagnostics, Medical Diagnostics Karolinska, Karolinska University Hospital, Huddinge, and the Division for of Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Obstet Gynecol. 2023 Sep 1;142(3):679-687. doi: 10.1097/AOG.0000000000005286.
To evaluate the risk for cervical intraepithelial neoplasia grade 3 (CIN 3) or worse (including adenocarcinoma in situ [AIS] and invasive cervical cancer) associated with non-16/18 human papillomavirus (HPV) types (other HPV) among women with atypical glandular cells (AGC) in cervical cytology.
This population-based cohort study evaluates the risk of CIN 3 or worse associated with other HPV types. Human papillomavirus genotyping was performed on Pap tests collected in Sweden from 341 women with AGC that were positive for other HPV types from February 17, 2014, to December 31, 2018. The women were followed for histopathologic outcomes using comprehensive registry linkages until December 31, 2019. Cumulative incidence proportions of CIN 3 or worse by specific HPV type were calculated using 1-minus Kaplan-Meier function. Hazard ratios (HRs) for CIN 3 or worse were generated using multivariate Cox regression.
Of 341 women, 134 (39.3%) had CIN 3-AIS, but there were only five (1.5%) women in the cohort with invasive cervical cancer. Human papillomavirus 45 preceded 80.0% of invasive cervical cancer cases. Among women positive for HPV33, 82.9% (95% CI 58.0-97.3%) had CIN 3 or worse during follow-up. Positivity for HPV31 conferred the highest HR for CIN 3 or worse relative to other types, both in primary cytology and primary HPV screening (HR 2.71, 95% CI 1.47-5.00 and HR 3.41, 95% CI 1.95-5.96, respectively).
Among non-16/18 HPV types in AGC, HPV31 and 33 had the highest risk for CIN 3 or worse, whereas most of the women with invasive cancer were positive for HPV45. Extended HPV genotyping may be helpful for the management of AGC.
评估宫颈细胞学检查中出现非 16/18 型人乳头瘤病毒（HPV）（其他 HPV 型）的不典型腺细胞（AGC）妇女中，与宫颈上皮内瘤变 3 级（CIN 3）或更高级别病变（包括原位腺癌 [AIS] 和浸润性宫颈癌）相关的风险。
本基于人群的队列研究评估了与其他 HPV 型相关的 CIN 3 或更高级别病变的风险。对 2014 年 2 月 17 日至 2018 年 12 月 31 日期间在瑞典进行的 HPV 基因分型检测呈阳性的 341 例其他 HPV 型 AGC 妇女的巴氏涂片进行 HPV 基因分型。通过综合登记册链接对这些妇女进行了组织病理学结局的随访，直至 2019 年 12 月 31 日。使用 1 减 Kaplan-Meier 函数计算特定 HPV 型的 CIN 3 或更高级别病变的累积发生率。使用多变量 Cox 回归计算 CIN 3 或更高级别病变的风险比（HR）。
在 341 例妇女中，134 例（39.3%）患有 CIN 3-AIS，但在该队列中仅有 5 例（1.5%）患有浸润性宫颈癌。HPV45 首先发生于 80.0%的浸润性宫颈癌病例。在 HPV33 阳性的妇女中，82.9%（95%CI58.0-97.3%）在随访期间患有 CIN 3 或更高级别病变。与其他类型相比，HPV31 阳性的妇女发生 CIN 3 或更高级别病变的风险最高，无论是在原发性细胞学检查还是原发性 HPV 筛查中（HR2.71，95%CI1.47-5.00；HR3.41，95%CI1.95-5.96）。
在 AGC 中的非 16/18 型 HPV 中，HPV31 和 33 与 CIN 3 或更高级别病变的相关性最高，而大多数浸润性癌患者的 HPV45 呈阳性。扩展 HPV 基因分型可能有助于 AGC 的管理。
