Chen Shimin, Hu Shangying, Yin Jian, Yu Wenying, Zhang Xun, Deng Xi, Ding Huaxin, Zhang Jinyu, Song Yan, Wang Qiming, Chen Liang, Guo Feng, Hartwig Susanne, Zhao Fanghui
Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, P.O. Box 2258, Beijing, 100021, China.
School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
Infect Agent Cancer. 2024 Sep 12;19(1):43. doi: 10.1186/s13027-024-00598-z.
The region-specific importance of carcinogenic HPV genotypes is required for optimizing HPV-based screening and promoting appropriate multivalent HPV prophylactic vaccines. This information is lacking for Ningbo, one of the first cities of China's Healthy City Innovation Pilot Program for Cervical Cancer Elimination. Here, we investigated high-risk HPV (HR-HPV) genotype-specific distribution and attribution to biopsy-confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+) before mass vaccination in Ningbo, China.
A total of 1393 eligible CIN2+ archived blocks (including 161 CIN2, 1107 CIN3, and 125 invasive cervical cancers [ICC]) were collected from 2017 to 2020 in Ningbo. HR-HPV DNA was genotyped using the SPF-DEIA-LiPA version 1 detection system and the SureX HPV 25X Genotyping Kit. Genotype-specific attribution to CIN2+ was estimated using a fractional contribution approach.
Ranking by the attributable proportions, HPV16 remained the most important genotype in both cervical precancers and cancers, accounting for 36.8% of CIN2, 53.2% of CIN3, and 73.3% of ICC cases. Among cervical precancers, HPV52 (17.3% in CIN2, 12.7% in CIN3) and HPV58 (13.9%, 14.9%) ranked second and third, while HPV33 (8.3%, 7.9%) and HPV31 (6.5%, 4.1%) ranked fourth and fifth, respectively. However, among ICCs, HPV18 (5.7%) accounted for the second highest proportion, followed by HPV33 (5.4%), HPV58 (4.0%), and HPV45 (3.2%). HPV18/45 together accounted for 46.8% of adenocarcinomas, which was slightly lower than that of HPV16 (47.7%). The remaining HR-HPV genotypes (HPV35/39/51/56/59/66/68) combined accounted for only 6.7% of CIN2, 2.9% of CIN3, and 4.2% of ICC.
With Ningbo's strong medical resources, it will be important to continue HPV16/18 control efforts, and could broaden to HPV31/33/45/52/58 for maximum health benefits. However, different strategies should be proposed for other HR-HPV genotypes based on their lower carcinogenic risks.
为优化基于人乳头瘤病毒（HPV）的筛查并推广合适的多价HPV预防性疫苗，需要了解致癌HPV基因型的区域特异性重要性。中国宫颈癌消除健康城市创新试点项目首批城市之一的宁波缺乏此类信息。在此，我们调查了中国宁波大规模疫苗接种前，高危HPV（HR-HPV）基因型特异性分布及其对活检确诊的2级或更高级别宫颈上皮内瘤变（CIN2+）的归因。
2017年至2020年期间，在宁波共收集了1393个符合条件的CIN2+存档组织块（包括161个CIN2、1107个CIN3和125例浸润性宫颈癌[ICC]）。使用SPF-DEIA-LiPA 1.0检测系统和SureX HPV 25X基因分型试剂盒对HR-HPV DNA进行基因分型。采用分数贡献法估计CIN2+的基因型特异性归因。
按归因比例排序，HPV16在宫颈上皮内瘤变和宫颈癌中仍是最重要的基因型，占CIN2病例的36.8%、CIN3病例的53.2%和ICC病例的73.3%。在宫颈上皮内瘤变中，HPV52（CIN2中占17.3%，CIN3中占12.7%）和HPV58（分别为13.9%、14.9%）排名第二和第三，而HPV33（8.3%、7.9%）和HPV31（6.5%、4.1%）分别排名第四和第五。然而，在ICC中，HPV18（5.7%）占比第二高，其次是HPV33（5.4%）、HPV58（4.0%）和HPV45（3.2%）。HPV18/45共同占腺癌的46.8%，略低于HPV16（47.7%）。其余HR-HPV基因型（HPV35/39/51/56/59/66/68）合计仅占CIN2的6.7%、CIN3的2.9%和ICC的4.2%。
凭借宁波强大的医疗资源，继续开展HPV16/18防控工作很重要，并且可以扩大到HPV31/33/45/52/58，以实现最大健康效益。然而，对于其他致癌风险较低的HR-HPV基因型，应提出不同的策略。
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