Downey G P, Bavin P J, Deery A R, Crow J, Griffiths P D, Emery V C, Walker P G
Department of Obstetrics and Gynaecology, Royal Free Hospital and School of Medicine, London, UK.
Lancet. 1994 Aug 13;344(8920):432-5. doi: 10.1016/s0140-6736(94)91768-x.
We have previously reported that among 200 women referred for colposcopy with smears suggesting mild dyskaryosis, medium or high copy numbers of human papillomavirus type 16 (HPV16) DNA identified patients with current high-grade cervical disease. We have followed up 95 women from that group who had histologically proven mild-grade cervical disease (cervical intraepithelial neoplasia grade 1, n = 37) or wart virus infection (n = 12) or who had no evidence of cervical abnormality at study entry (n = 43). Kaplan-Meier survival analysis of the 70 months' follow-up was used to identify baseline features that might affect the risk of progression. 3 women were lost to follow-up; data were available for the remaining 92. Among the whole group the probability of remaining free of high-grade cervical disease was 0.71. Women with a histological diagnosis of minor-grade disease were more likely to progress to high-grade disease than those with no evidence of abnormality (proportion disease-free 0.52 vs 0.90, p = 0.004). Stratification of the group according to median age (28 years) revealed a weak association between age and disease progression (p = 0.04). There was no difference in disease-free probability between HPV16-positive and HPV16-negative women (0.75 vs 0.65, p = 0.19). Nor was there a significant difference in disease-free probability when the group was stratified by HPV16 viral burden. These data show that a histological diagnosis of minor-grade cervical disease is a better long-term predictor of disease progression than is HPV16 positivity, irrespective of copy number. These findings do not support the simple view that HPV16 alone is the cause of high-grade cervical disease, including cancer.
我们之前曾报道，在200名因涂片提示轻度核异质而转诊接受阴道镜检查的女性中，16型人乳头瘤病毒（HPV16）DNA的中等或高拷贝数可识别出当前患有高级别宫颈疾病的患者。我们对该组中的95名女性进行了随访，这些女性经组织学证实患有轻度宫颈疾病（宫颈上皮内瘤变1级，n = 37）或疣病毒感染（n = 12），或者在研究开始时没有宫颈异常的证据（n = 43）。采用Kaplan-Meier生存分析对70个月的随访结果进行分析，以确定可能影响疾病进展风险的基线特征。3名女性失访；其余92名女性的数据可用。在整个组中，保持无高级别宫颈疾病的概率为0.71。组织学诊断为轻度疾病的女性比没有异常证据的女性更有可能进展为高级别疾病（无疾病比例为0.52对0.90，p = 0.004）。根据年龄中位数（28岁）对该组进行分层，结果显示年龄与疾病进展之间存在微弱关联（p = 0.04）。HPV16阳性和HPV16阴性女性的无病概率没有差异（0.75对0.65，p = 0.19）。当根据HPV16病毒载量对该组进行分层时，无病概率也没有显著差异。这些数据表明，组织学诊断为轻度宫颈疾病比HPV16阳性更能长期预测疾病进展，无论拷贝数多少。这些发现不支持单纯认为HPV16是包括癌症在内的高级别宫颈疾病病因的观点。
