Dang Xiaoqing, Lu Quanlong, Li Jing, Li Ruifang, Feng Bo, Wang Chen, Gao Lifang, Feng Ruimei, Wang Zhilian
Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Taiyuan, China.
Department of Pathology, The Second Hospital of Shanxi Medical University, Taiyuan, China.
Front Oncol. 2024 Feb 15;14:1353580. doi: 10.3389/fonc.2024.1353580. eCollection 2024.
The etiology and clinical presentation of vulvar carcinomas, especially vulvar lesions, are not fully understood. Because the vulva and cervix are anatomically connected, human papillomavirus (HPV) is the main cause of cervical lesions. Thus, this study explored the potential characteristics and effects of specific HPV infection types across vulvar lesions and concurrent cervical lesions.
This retrospective, cross-sectional study analyzed patients with cervical HPV or cytological results and concurrent vulvar biopsy who were seen in our hospital colposcopy clinic in Shanxi Province, China, between 2013 and 2023. Data on age, menopause status, vulvar manifestations, and cytology and HPV infection testing results were collected. Attributable fractions and multinominal logistic models were used to evaluate HPV genotyping and clinical characteristics across vulvar lesions.
Among the 1,027 participants, 83 (8.1%) had vulvar intraepithelial neoplasia (VIN) of high grade or worse (VIN2+), and 127 (12.4%) had non-neoplastic epithelial disorders of the vulva (NNEDV). A total of 175 patients had either VIN2+ or cervical intraepithelial neoplasia (CIN) lesions of grade 2 or worse (CIN2+). The most common HPV genotypes for VIN2+ or concurrent VIN2+/CIN2+ were HPV16, HPV52, and HPV58, although attributable fractions differed among lesions. Patients with normal cytological or histopathological result were more likely to have NNEDV detected, while abnormal cervical diagnosis was associated with higher detection of VIN2+. Multinominal logistic modeling showed that age and HPV16 infection were risk factors for VIN2+ or concurrent VIN2+/CIN2+; however, only vulvar presentation with depigmentation was a risk factor for NNEDV. Among patients with low-grade CIN1/VIN1, compared with those who were HPV16 negative, those who were HPV16 positive were at 6.63-fold higher risk of VIN2+/CIN2+ [95% confidence interval (CI): 3.32, 13.21]. Vulvar depigmentation was also associated with increased risk of NNEDV (odds ratio: 9.98; 95% CI: 3.02, 33.04).
Chinese women may be at specific, high risk for HPV infection types associated with VIN or CIN. The use of cervical cell HPV detection along with vulvar presentation during cervical cancer screening may also contribute to vulvar lesion detection.
外阴癌，尤其是外阴病变的病因和临床表现尚未完全明确。由于外阴和宫颈在解剖学上相连，人乳头瘤病毒（HPV）是宫颈病变的主要原因。因此，本研究探讨了特定HPV感染类型在外阴病变及并发宫颈病变中的潜在特征和影响。
这项回顾性横断面研究分析了2013年至2023年间在中国山西省我院阴道镜门诊就诊的有宫颈HPV或细胞学检查结果并同时进行外阴活检的患者。收集了年龄、绝经状态、外阴表现以及细胞学和HPV感染检测结果的数据。使用归因分数和多项逻辑模型评估外阴病变中的HPV基因分型和临床特征。
在1027名参与者中，83人（8.1%）患有高级别或更严重的外阴上皮内瘤变（VIN2+），127人（12.4%）患有外阴非肿瘤性上皮疾病（NNEDV）。共有175名患者患有VIN2+或2级或更严重的宫颈上皮内瘤变（CIN2+）。VIN2+或并发VIN2+/CIN2+最常见的HPV基因型是HPV16、HPV52和HPV58，尽管不同病变的归因分数有所不同。细胞学或组织病理学结果正常的患者更有可能检测出NNEDV，而宫颈诊断异常与VIN2+的更高检出率相关。多项逻辑模型显示，年龄和HPV16感染是VIN2+或并发VIN2+/CIN2+的危险因素；然而，只有外阴出现色素脱失是NNEDV的危险因素。在低级别CIN1/VIN1患者中，与HPV16阴性者相比，HPV16阳性者发生VIN2+/CIN2+的风险高6.63倍[95%置信区间（CI）：3.32，13.21]。外阴色素脱失也与NNEDV风险增加相关（优势比：9.98；95%CI：3.02，33.04）。
中国女性可能对与VIN或CIN相关的特定HPV感染类型具有高风险。在宫颈癌筛查期间，结合宫颈细胞HPV检测和外阴表现也可能有助于检测外阴病变。
