Abstract：
National HPV vaccination coverage in Japan is less than one percent of the eligible population and cervical cancer incidence and mortality are increasing. This systematic review and meta-analysis aimed to provide a comprehensive estimate of HPV genotype prevalence for Japan.
English and Japanese databases were searched to March 2021 for research reporting HPV genotypes in cytology and histology samples from Japanese women. Summary estimates were calculated by disease stage from cytology only assessment - Normal, ASCUS, LSIL, HSIL and from histological assessment - CIN1, CIN2, CIN3/AIS, ICC (ICC-SCC, and ICC-ADC), and other. A random-effects meta-analysis was used to calculate summary prevalence estimates of any-HPV, high-risk (HR) and low-risk (LR) vaccine types, and vaccine genotypes (bivalent, quadrivalent, or nonavalent). This study was registered with PROSPERO: CRD42018117596.
A total of 57759 women with normal cytology, 1766 ASCUS, 3764 LSIL, 2017 HSIL, 3130 CIN1, 1219 CIN2, 869 CIN3/AIS, and 4306 ICC (which included 1032 ICC-SCC, and 638 ICC-ADC) were tested for HPV. The summary estimate of any-HPV genotype in women with normal cytology was 15·6% (95% CI: 12·3-19·4) and in invasive cervical cancer (ICC) was 85·6% (80·7-89·8). The prevalence of HR-HPV was 86·0% (95% CI: 73·9-94·9) for cytological cases of HSIL, 76·9% (52·1-94·7) for histological cases of CIN3/AIS, and 75·7% (68·0-82·6) for ICC. In women with ICC, the summary prevalence of bivalent vaccine genotypes was 58·5% (95% CI: 52·1-64·9), for quadrivalent genotypes was 58·6% (52·2-64·9) and for nonavalent genotypes was 71·5% (64·9-77·6), and of ICC cases that were HPV positive over 90% of infections are nonavalent vaccine preventable. There was considerable heterogeneity in all HPV summary estimates and for ICC, this heterogeneity was not explained by variability in study design, sample type, HPV assay type, or HPV DNA detection method, although studies published in the 1990s had lower prevalence estimates of any-HPV and HR HPV genotypes.
HPV prevalence is high among Japanese women. The nonavalent vaccine is likely to have the greatest impact on reducing cervical cancer incidence and mortality in Japan.
English and Japanese databases were searched to March 2021 for research reporting HPV genotypes in cytology and histology samples from Japanese women. Summary estimates were calculated by disease stage from cytology only assessment - Normal, ASCUS, LSIL, HSIL and from histological assessment - CIN1, CIN2, CIN3/AIS, ICC (ICC-SCC, and ICC-ADC), and other. A random-effects meta-analysis was used to calculate summary prevalence estimates of any-HPV, high-risk (HR) and low-risk (LR) vaccine types, and vaccine genotypes (bivalent, quadrivalent, or nonavalent). This study was registered with PROSPERO: CRD42018117596.
A total of 57759 women with normal cytology, 1766 ASCUS, 3764 LSIL, 2017 HSIL, 3130 CIN1, 1219 CIN2, 869 CIN3/AIS, and 4306 ICC (which included 1032 ICC-SCC, and 638 ICC-ADC) were tested for HPV. The summary estimate of any-HPV genotype in women with normal cytology was 15·6% (95% CI: 12·3-19·4) and in invasive cervical cancer (ICC) was 85·6% (80·7-89·8). The prevalence of HR-HPV was 86·0% (95% CI: 73·9-94·9) for cytological cases of HSIL, 76·9% (52·1-94·7) for histological cases of CIN3/AIS, and 75·7% (68·0-82·6) for ICC. In women with ICC, the summary prevalence of bivalent vaccine genotypes was 58·5% (95% CI: 52·1-64·9), for quadrivalent genotypes was 58·6% (52·2-64·9) and for nonavalent genotypes was 71·5% (64·9-77·6), and of ICC cases that were HPV positive over 90% of infections are nonavalent vaccine preventable. There was considerable heterogeneity in all HPV summary estimates and for ICC, this heterogeneity was not explained by variability in study design, sample type, HPV assay type, or HPV DNA detection method, although studies published in the 1990s had lower prevalence estimates of any-HPV and HR HPV genotypes.
HPV prevalence is high among Japanese women. The nonavalent vaccine is likely to have the greatest impact on reducing cervical cancer incidence and mortality in Japan.
摘要：
背景：日本全国HPV疫苗接种覆盖率不到合格人群的百分之一，宫颈癌发病率和死亡率正在上升。本系统综述和荟萃分析旨在提供日本HPV基因型患病率的综合评估。
方法：检索到2021年3月的英文和日文数据库，研究报告来自日本女性的细胞学和组织学样本中的HPV基因型。根据仅细胞学评估的疾病阶段计算汇总估计值-正常，ASCUS,LSIL,HSIL和组织学评估-CIN1，CIN2，CIN3/AIS，ICC(ICC-SCC,和ICC-ADC），和其他。随机效应荟萃分析用于计算任何HPV的汇总患病率估计值，高风险（HR）和低风险（LR）疫苗类型，和疫苗基因型(二价，四价，或非共价)。本研究注册于PROSPERO:CRD42018117596。
结果：总共57759名细胞学正常的妇女，1766ASCUS,3764LSIL,2017HSIL,3130CIN1,1219CIN2,869CIN3/AIS,和4306ICC(其中包括1032ICC-SCC，和638ICC-ADC）检测HPV。在细胞学正常的女性中，任何HPV基因型的汇总估计为15·6％（95％CI：12·3-19·4），在浸润性宫颈癌（ICC）中为85·6％（80·7-89·8）。对于HSIL的细胞学病例，HR-HPV的患病率为86·0％（95％CI：73·9-94·9），76·9%(52·1-94·7)的CIN3/AIS组织学病例，ICC占75·7%（68·0-82·6）。在有ICC的女性中，二价疫苗基因型的总流行率为58·5%(95%CI:52·1-64·9)，四价基因型为58·6％（52·2-64·9），非价基因型为71·5％（64·9-77·6），在HPV阳性的ICC病例中,90%以上的感染是可以预防的非价疫苗.所有HPV汇总估计和ICC都存在相当大的异质性，这种异质性不能用研究设计的可变性来解释，样品类型,HPV检测类型,或HPVDNA检测方法，尽管1990年代发表的研究对任何HPV和HRHPV基因型的患病率估计较低.
结论：日本女性的HPV患病率很高。在日本，非单价疫苗可能对降低宫颈癌发病率和死亡率产生最大的影响。
方法：检索到2021年3月的英文和日文数据库，研究报告来自日本女性的细胞学和组织学样本中的HPV基因型。根据仅细胞学评估的疾病阶段计算汇总估计值-正常，ASCUS,LSIL,HSIL和组织学评估-CIN1，CIN2，CIN3/AIS，ICC(ICC-SCC,和ICC-ADC），和其他。随机效应荟萃分析用于计算任何HPV的汇总患病率估计值，高风险（HR）和低风险（LR）疫苗类型，和疫苗基因型(二价，四价，或非共价)。本研究注册于PROSPERO:CRD42018117596。
结果：总共57759名细胞学正常的妇女，1766ASCUS,3764LSIL,2017HSIL,3130CIN1,1219CIN2,869CIN3/AIS,和4306ICC(其中包括1032ICC-SCC，和638ICC-ADC）检测HPV。在细胞学正常的女性中，任何HPV基因型的汇总估计为15·6％（95％CI：12·3-19·4），在浸润性宫颈癌（ICC）中为85·6％（80·7-89·8）。对于HSIL的细胞学病例，HR-HPV的患病率为86·0％（95％CI：73·9-94·9），76·9%(52·1-94·7)的CIN3/AIS组织学病例，ICC占75·7%（68·0-82·6）。在有ICC的女性中，二价疫苗基因型的总流行率为58·5%(95%CI:52·1-64·9)，四价基因型为58·6％（52·2-64·9），非价基因型为71·5％（64·9-77·6），在HPV阳性的ICC病例中,90%以上的感染是可以预防的非价疫苗.所有HPV汇总估计和ICC都存在相当大的异质性，这种异质性不能用研究设计的可变性来解释，样品类型,HPV检测类型,或HPVDNA检测方法，尽管1990年代发表的研究对任何HPV和HRHPV基因型的患病率估计较低.
结论：日本女性的HPV患病率很高。在日本，非单价疫苗可能对降低宫颈癌发病率和死亡率产生最大的影响。
