Laboratory of Experimental Pathology, GIGA-Cancer (B23 + 4), University of Liege, Liege, Belgium.
Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Med Virol. 2023 Oct;95(10):e29190. doi: 10.1002/jmv.29190.
Cervical glandular neoplasms represent a heterogeneous group of tumors for which a comprehensive overview of the involvement of high-risk human papillomaviruses (HPV) in pathogenesis is still lacking. We first searched MEDLINE (PubMed), Embase, and Scopus databases (until October 2022), and systematically reviewed available literature. We then quantitatively estimated both pooled and genotype-specific prevalence of HPV DNA as well as the influence of various factors (e.g., geographical region, histological subtype, tissue/sample type) on computed effect size by means of random effects meta-analysis. In total, 379 studies comprising 17 129 cases of cervical adenocarcinoma were identified. The pooled HPV prevalence was 78.4% (95% confidence interval [95% CI]: 76.2-80.3) with a significant between-study heterogeneity (I = 79.4%, Q test p < 0.0001). Subgroup analyses indicated that the effect size differed substantially by geographical region (from 72.5% [95% CI: 68.7-76.1] in Asia to 86.8% [95% CI: 82.2-90.3] in Oceania) (p < 0.0001) and histological subtype of cancer (from 9.8% [95% CI: 5.5-17] in gastric-type to 85% [95% CI: 79.6-89.2] in usual-type cervical adenocarcinoma) (p < 0.0001). HPV16 and HPV18 were by far the most frequently detected viral strains with specific prevalence of 49.8% (95% CI: 46.9-52.6) and 45.3% (95% CI: 42.8-47.8), respectively. When stratified by continent or histologic variant, these genotype-specific results varied in a relatively limited manner. Altogether, these findings support that all histological subtypes of cervical adenocarcinoma are etiologically linked to high-risk HPV but to varying degrees. Therefore, a dual-criteria classification taking into account accurately both morphological and virological aspects could be an interesting evolution of the current binary World Health Organization classification, better reflecting the pathogenic diversity of the disease.
宫颈腺肿瘤是一组异质性肿瘤，目前仍缺乏对高危型人乳头瘤病毒（HPV）在发病机制中的全面认识。我们首先检索了 MEDLINE（PubMed）、Embase 和 Scopus 数据库（截至 2022 年 10 月），并对现有文献进行了系统回顾。然后，我们通过随机效应荟萃分析定量估计了 HPV DNA 的总流行率和基因型特异性流行率，以及各种因素（如地理位置、组织学亚型、组织/样本类型）对计算得出的效应量的影响。总共确定了 379 项研究，包括 17129 例宫颈腺癌病例。HPV 的总流行率为 78.4%（95%置信区间[95%CI]：76.2-80.3），存在显著的异质性（I = 79.4%，Q 检验，p<0.0001）。亚组分析表明，效应量在地理位置（从亚洲的 72.5%[95%CI：68.7-76.1]到大洋洲的 86.8%[95%CI：82.2-90.3]）和癌症的组织学亚型（从胃型的 9.8%[95%CI：5.5-17]到普通型宫颈腺癌的 85%[95%CI：79.6-89.2]）之间存在显著差异（p<0.0001）。HPV16 和 HPV18 是迄今为止最常检测到的病毒株，其特定流行率分别为 49.8%（95%CI：46.9-52.6）和 45.3%（95%CI：42.8-47.8）。按大陆或组织学变异体分层时，这些基因型特异性结果的变化幅度相对较小。总之，这些发现支持所有组织学亚型的宫颈腺癌在病因上都与高危型 HPV 相关，但程度不同。因此，一种同时考虑形态学和病毒学方面的双重标准分类方法可能是当前世卫组织二分法的一个有趣发展，更好地反映了疾病的发病多样性。
