■持续的人乳头瘤病毒(HPV)感染仍然是宫颈癌的关键危险因素。基于HPV的初筛在临床指南中被广泛推荐,与细胞学相比,需要进一步的纵向研究来优化检测高级别宫颈病变的策略。
■从2015年11月到2023年12月,31,942名参与者被纳入现实世界的观察研究。其中,4,219名参与者接受了至少两轮HPV测试,397人完成了三轮HPV检测。所有参与者均接受了高危型HPV16/18/31/33/35/39/45/51/52/56/58/59/66/68(hrHPV)和低危型HPV6/11基因分型检测。一些参与者还接受了细胞学检查或阴道镜检查。
■在横截面队列中,hrHPV和所有HPV亚型的患病率分别为6.6%(2,108/31,942)和6.8%(2,177/31,942),分别。前三个hrHPV基因型是HPV52(1.9%),HPV58(0.9%),和HPV16(0.9%)。年龄分布在45-49岁和60-65岁出现两个高峰。对于初级筛查队列,hrHPV患病率从2015-2017年的4.8%上升至2020年的7.0%,最终在2023年达到7.2%.对于纵向队列研究,重复人群中的hrHPV患病率(3.9、5.3和6.0%)低于初次hrHPV筛查率(6.6%),这表明重复筛查可能会降低患病率。方法上,hrHPV(89.5%)和16种亚型筛查组(92.3%)的敏感性优于细胞学组(54.4%).此外,纵向研究表明,持续性hrHPV亚组的高级别鳞状上皮内病变和更多组织学进展事件的发生率明显更高(p=0.04)(7/17vs.0/5)比再感染组。
■这项研究表明,东莞的高危型HPV患病率正在上升,反复筛查减少了这种趋势。研究结果支持基于HPV的初筛,并可能指导华南地区的HPV疫苗接种和宫颈癌预防。
UNASSIGNED: Persistent human papillomavirus (HPV) infection remains a key risk factor for cervical cancer. HPV-based primary screening is widely recommended in clinical guidelines, and further longitudinal studies are needed to optimize strategies for detecting high-grade cervical lesions compared to cytology.
UNASSIGNED: From November 2015 to December 2023, 31,942 participants were included in the real-world observational study. Among those, 4,219 participants underwent at least two rounds of HPV tests, and 397 completed three rounds of HPV tests. All participants were tested for high-risk types of HPV 16/18/31/33/35/39/45/51/52/56/58/59/66/68 (hrHPV) and low-risk types of HPV6/11 genotyping. Some participants also received cytology or colposcopy with pathology.
UNASSIGNED: In the cross-sectional cohort, the prevalence of hrHPV and all HPV subtypes was 6.6% (2,108/31,942) and 6.8% (2,177/31,942), respectively. The three top hrHPV genotypes were HPV52 (1.9%), HPV58 (0.9%), and HPV16 (0.9%). Age distributions showed two peaks at 45-49 and 60-65 years. For the primary screening cohort, the hrHPV prevalence rate increased from 4.8% in 2015-2017 to 7.0% in 2020-2020 and finally reached 7.2% in 2023. For the longitudinal cohort study, the hrHPV prevalence rates in the repeated population (3.9, 5.3, and 6.0%) were lower than the primary hrHPV screening rates (6.6%), which indicated that repeated screening might decrease the prevalence rate. Methodologically, the hrHPV (89.5%) and the screening group of 16 subtypes (92.3%) demonstrated superior sensitivity than the cytology group (54.4%). Moreover, the longitudinal study indicated that the persistent hrHPV subgroup had a significantly higher (p = 0.04) incidence of high-grade squamous intraepithelial lesions and more histology progression events (7/17 vs. 0/5) than the reinfection group.
UNASSIGNED: The study indicates a rising high-risk HPV prevalence in Dongguan, with repeated screening reducing this trend. The findings support HPV-based primary screening and might guide HPV vaccination and cervical cancer prevention in South
China.