<br>女性肛门 HPV 感染和高级肛门病变的宫颈决定因素：协作汇总分析。,The Lancet Infectious Diseases

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女性肛门 HPV 感染和高级肛门病变的宫颈决定因素：协作汇总分析。
The Lancet Infectious Diseases ( IF 36.4 ) Pub Date : 2019-06-13 , DOI: 10.1016/s1473-3099(19)30164-1
Chunqing Lin ₁ , Jiri Slama ₂ , Paula Gonzalez ₃ , Marc T Goodman ₄ , Ningshao Xia ₅ , Aimée R Kreimer ₆ , Ting Wu ₅ , Nancy A Hessol ₇ , Yurii Shvetsov ₈ , Ana P Ortiz ₉ , Beatriz Grinsztejn ₁₀ , Anna-Barbara Moscicki ₁₁ , Isabelle Heard ₁₂ , María Del Refugio González Losa ₁₃ , Erna M Kojic ₁₄ , Maarten F Schim van der Loeff ₁₅ , Feixue Wei ₅ , Adhemar Longatto-Filho ₁₆ , Zizipho A Mbulawa ₁₇ , Joel M Palefsky ₇ , Annette H Sohn ₁₈ , Brenda Y Hernandez ₈ , Katina Robison ₁₉ , Steve Simpson ₂₀ , Lois J Conley ₂₁ , Alexandra de Pokomandy ₂₂ , Marianne A B van der Sande ₂₃ , Racheal S Dube Mandishora ₂₄ , Lays P B Volpini ₂₅ , Alessandra Pierangeli ₂₆ , Byron Romero ₃ , Timothy Wilkin ₂₇ , Silvia Franceschi ₂₈ , Carmen Hidalgo-Tenorio ₂₉ , Reshmie A Ramautarsing ₃₀ , Ina U Park ₃₁ , Fernanda K Tso ₃₂ , Sheela Godbole ₃₃ , Kathleen W M D'Hauwers ₃₄ , Borek Sehnal ₂ , Lynette J Menezes ₃₅ , Sandra A Heráclio ₃₆ , Gary M Clifford ₃₇

Affiliation

International Agency for Research on Cancer, Lyon, France; National Cancer Center, National Clinical Research Center for Cancer, and Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Gynecology and Obstetrics, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic.
Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica.
Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.
State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China.
National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
University of California, San Francisco, CA, USA.
University of Hawaii Cancer Center, Honolulu, Hawaii, USA.
University of Puerto Rico Comprehensive Cancer Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, UPR, San Juan, Puerto Rico.
Instituto Nacional de Infectologia Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil.
David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Department of Endocrinology and Reproductive Medicine, IE3M, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique, Hôpitaux de Paris, Paris, France.
Dr Hideyo Noguchy Center of Regional Investigations, Autonomous University of Yucatán, Mérida, Yucatán, México.
Mount Sinai West and St Luke's Hospitals, New York, NY, USA.
Department of Infectious Diseases, Infectious Diseases Research & Prevention, GGD Amsterdam, Netherlands.
Research Institute of Life and Health Sciences, School of Medicine, University of Minho, Braga, Portugal; 3B's (Biomaterials, Biodegradables and Biomimetics) Research Group, Portugal Government Associate Laboratory, Braga, Portugal; Laboratory of Medical Investigation 14, Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil; Teaching and Research Institute, Molecular Oncology Research Center, Barretos Cancer Hospital-Pio XII Foundation, Barretos, Brazil.
Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa; Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; South African Medical Research Council Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa.
TREAT Asia/amfAR-Foundation for AIDS Research, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
Obstetrics & Gynecology and Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
Division of HIV/AIDS Prevention, Epidemiology Research Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Chronic Viral Illness Service, McGill University Health Centre and Department of Family Medicine, McGill University, Montreal, QC, Canada.
Public Health Epidemiology, Head Department Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Department of Medical Microbiology, University of Zimbabwe College of Health Sciences, Parirenyatwa Hospital premises, Harare, Zimbabwe.
Health Sciences Center, Federal University of Espírito Santo, Vitória, Brazil.
Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
Weill Cornell Medicine, New York, NY, USA.
Aviano Cancer Center, Aviano, Italy.
Infectious Diseases Service, University Hospital Virgen de las Nieves, Granada, Spain.
Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA.
Department of Gynecology of the Federal University of São Paulo, São Paulo, Brazil.
Division of Epidemiology and Biostatistics, ICMR-National AIDS Research Institute, Indian Council of Medical Research, Pune, India.
Radboud University Nijmegen, Medical Centre, Department of Urology, Nijmegen, Netherlands.
Division of Infectious Disease, University of South Florida, Tampa, FL, USA.
Women's Healthcare Center, Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil; Cytopathology Division, Public Health Laboratory of the State of Pernambuco, Recife, PE, Brazil.
International Agency for Research on Cancer, Lyon, France.

背景

宫颈癌筛查可能有助于预防女性肛门癌。我们的目的是调查常规宫颈癌筛查结果（即高危人乳头瘤病毒 (HPV) 感染和细胞组织病理学）是否可以预测肛门 HPV16 感染、肛门高级鳞状上皮内病变 (HSIL) 以及肛门癌。

方法

我们对截至 2018 年 8 月 31 日发表的关于肛门 HPV 和 HSIL 宫颈决定因素研究的 MEDLINE、Embase 和 Cochrane 图书馆进行了系统回顾。我们集中重新分析了来自 13 427 名女性的个人水平数据，其中包括配对的宫颈和肛门样本36项研究。我们使用患病率 (PR) 和 95% CI，按 HIV 状况、宫颈高危 HPV、宫颈细胞组织病理学、年龄及其组合比较了肛门高危 HPV 患病率。在 3255 名具有肛门细胞组织病理学结果的女性中，对所有肛门 HSIL 和 HPV16 阳性肛门 HSIL 的 PR 进行了类似计算。

发现

宫颈和肛门 HPV 感染高度相关。在 HIV 阴性女性中，宫颈 HPV16 阳性女性的肛门 HPV16 患病率为 41% (447/1097)，而宫颈 HPV16 阴性女性的肛门 HPV16 患病率为 2% (214/8663)（PR 16·5，95% CI 14·2–19） ·2, p<0·0001); HIV 阳性女性的这一数值分别为 46% (125/273) 和 11% (272/2588) (4·4, 3·7–5·3, p<0·0001)。肛门 HPV16 还与宫颈细胞组织病理学相关，HIV 阴性女性宫颈癌的患病率为 44% [101/228]（PR与正常细胞学 14·1、11·1–17·9、p<0·0001 ）。肛门 HSIL 与宫颈高危 HPV 相关，两者均发生在 HIV 阴性女性中（从宫颈高危 HPV 阴性女性的 2% [11/527] 到宫颈 HPV16 阳性女性的 24% [33/138] ；PR 12·9，95% CI 6·7–24·8，p<0·0001）和 HIV 阳性女性（从 8% [84/1094] 到 17% [31/186]；2·3， 1·6–3·4，p<0·0001）。肛门 HSIL 也与宫颈细胞组织病理学相关，两者均发生在 HIV 阴性女性中（从正常细胞学的 1% [5/498] 到宫颈 HSIL 的 22% [59/273]；PR 23·1、9·4–57 ·0, p<0·0001) 和 HIV 阳性女性（从 7% [105/1421] 到 25% [25/101]; 3·6, 2·5–5·3, p<0·0001）。在 45 岁以上宫颈 HPV16 阳性女性中，HPV16 阳性肛门 HSIL 的患病率为 23-25%（HIV 阴性女性为 5/20，HIV 阳性女性为 12/52）。

解释

基于 HPV 的宫颈癌筛查计划可能有助于对肛门癌风险进行分层，无论 HIV 状况如何。对于高危人群的有针对性的肛门癌二级预防而言，感染宫颈 HPV16 的 HIV 阴性女性，尤其是 45 岁以上的女性，与 HIV 阳性女性具有相似的肛门癌风险状况。

资金

国际癌症研究机构。

"点击查看英文标题和摘要"

Cervical determinants of anal HPV infection and high-grade anal lesions in women: a collaborative pooled analysis.

Background

Cervical cancer screening might contribute to the prevention of anal cancer in women. We aimed to investigate if routine cervical cancer screening results—namely high-risk human papillomavirus (HPV) infection and cytohistopathology—predict anal HPV16 infection, anal high-grade squamous intraepithelial lesions (HSIL) and, hence, anal cancer.

Methods

We did a systematic review of MEDLINE, Embase, and the Cochrane library for studies of cervical determinants of anal HPV and HSIL published up to Aug 31, 2018. We centrally reanalysed individual-level data from 13 427 women with paired cervical and anal samples from 36 studies. We compared anal high-risk HPV prevalence by HIV status, cervical high-risk HPV, cervical cytohistopathology, age, and their combinations, using prevalence ratios (PR) and 95% CIs. Among 3255 women with anal cytohistopathology results, PRs were similarly calculated for all anal HSIL and HPV16-positive anal HSIL.

Findings

Cervical and anal HPV infections were highly correlated. In HIV-negative women, anal HPV16 prevalence was 41% (447/1097) in cervical HPV16-positive versus 2% (214/8663) in cervical HPV16-negative women (PR 16·5, 95% CI 14·2–19·2, p<0·0001); these values were 46% (125/273) versus 11% (272/2588) in HIV-positive women (4·4, 3·7–5·3, p<0·0001). Anal HPV16 was also associated with cervical cytohistopathology, with a prevalence of 44% [101/228] for cervical cancer in HIV-negative women (PR vs normal cytology 14·1, 11·1–17·9, p<0·0001). Anal HSIL was associated with cervical high-risk HPV, both in HIV-negative women (from 2% [11/527] in cervical high-risk HPV-negative women up to 24% [33/138] in cervical HPV16-positive women; PR 12·9, 95% CI 6·7–24·8, p<0·0001) and HIV-positive women (from 8% [84/1094] to 17% [31/186]; 2·3, 1·6–3·4, p<0·0001). Anal HSIL was also associated with cervical cytohistopathology, both in HIV-negative women (from 1% [5/498] in normal cytology up to 22% [59/273] in cervical HSIL; PR 23·1, 9·4–57·0, p<0·0001) and HIV-positive women (from 7% [105/1421] to 25% [25/101]; 3·6, 2·5–5·3, p<0·0001). Prevalence of HPV16-positive anal HSIL was 23–25% in cervical HPV16-positive women older than 45 years (5/20 in HIV-negative women, 12/52 in HIV-positive women).

Interpretation

HPV-based cervical cancer screening programmes might help to stratify anal cancer risk, irrespective of HIV status. For targeted secondary anal cancer prevention in high-risk groups, HIV-negative women with cervical HPV16, especially those older than 45 years, have a similar anal cancer risk profile to that of HIV-positive women.

Funding

International Agency for Research on Cancer.

更新日期：2019-07-25

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