The prevalence and role of human papillomavirus genotypes in primary cervical screening in the northeast of China
BMC Cancer
The prevalence and role of human papillomavirus genotypes in primary cervical screening in the northeast of China
Shizhuo Wang 0
Heng Wei 0
Ning Wang 0
Shulan Zhang 0
Yao Zhang 0
Qiang Ruan 2
Weiguo Jiang 1
Qian Xiao 0
Xiaomei Luan 0
Xiuyan Qian 0
Lili Zhang 0
Xiang Gao 0
Xiaowei Sun 3
0 Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University , Shenyang, Liaoning , China
1 Department of Pathology, Shengjing Hospital, China Medical University , Shenyang, Liaoning , China
2 Virus Laboratory, Shengjing Hospital, China Medical University , Shenyang, Liaoning , China
3 Division of Pediatric Neurology, Weill Cornell Medical College , New York, NY10065 , USA
Background: Studies have shown that type-specific persistence of high-risk human papillomavirus (HPV) infection contributed significantly to cervical carcinogenesis. Methods: In this population-based study (on 24041 women), we report on the prevalent genotypes of HPVs and the prevalent genotypes of HPV persistent infection in the northeast of China. Results: Our results showed that in HPV infected women (45.6% in total), (95% CI, 44.97%-46.23%), 17.35% (95%CI, 16.87%-17.83%) suffered persistent infection. The most common high-risk HPV types in persistent positivity were HPV-16 (18.21%; 95%CI, 17.04%-19.38%), HPV-58 (13.2%; 95%CI, 12.17%-14.23%), HPV-18 (8.66%; 95%CI, 7.81%9.51%), HPV-52 (7.06%; 95% CI, 6.28%-7.84%) and HPV-33 (6.78%; 95% CI, 6.02%-7.54%). The prevalence of persistent infections with HPV-16,-58, 18, 52 and 33 in cervicitis were lower compared to those in CIN (all P < 0.05). HPV-58, 33 and multiple HPV persistent positivity were significantly associated with older age (all P < 0.05). HPV-18 persistent positivity was significantly associated with adenocarcinoma and lymphatic metastasis (all P < 0.05). HPV-18 persistent positivity was associated with cervical cancer prognosis (P <0.0001). Multivariate analyses showed that HPV-18 persistent positivity, (RR = 1.704, 95%CI = 1.095-2.654, p = 0.028) and lymphatic metastasis (RR = 2.304, 95% CI = 1.354-3.254, P = 0.015) were independent predictors for 3-year survival in cervical cancer. Conclusions: we provided extensive results of HPV genotype prevalence and distribution in the northeast of China. HPV genotyping is worthwhile to perform because of its independent prognostic value in cervical cancer
Human papillomavirus genotype; Cervical screening; Cervical cancer; Prognosis
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Background
Human Papillomavirus (HPV) infection usually proceeds
for the development of virtually all invasive cervical
cancers, their associated precancerous lesions, and genital
warts [1,2]. To date, more than 200 HPV genotypes have
been identified, but the interest is focused only on genital
HPVs (40 genotypes) that are associated with
precancerous and cancerous lesions of the cervix [3,4]. Although
high incidence and prevalence are found in females after
the onset of sexual activity, most of HPV infection are
transient and clear within 612 months. Studies showed
that type-specific persistence of high-risk human
papillomavirus (HPV) infection contributed significantly to
cervical carcinogenesis [5-7].
It is expected that the next-generation approach of
HPV vaccines may more efficiently prevent cervical
cancer, however, efforts to implement and evaluate a
vaccination strategy are dependent on our understanding of
the behaviors of HPV type-specific infection. Meanwhile,
the geographic variation in the prevalence and
distribution of HPV genotypes had been reported in different
countries, even different regions in the same country. Its
necessary for us to study the prevalence and role of
human papillomavirus genotypes in primary cervical
screening in different geographic regions [8,9]. We have
previously reported the prevalence of HPVs in 1444
Women in Liaoning Province, China [10]. However, no
large epidemiologic data has been reported in the
northeast of China.
We performed a population-based study (24041 women)
to investigate the prevalent high-risk genotypes of HPVs
and the results in HPV infected women in the northeast of
China. After they first visited, we randomly selected 15257
from those 24041 women, and followed them up to test
their HPV persistence as well as their pathological changes,
in order to study the association between the persistent
HPV infections and cervical lesions.
Methods
Enrolled group
From 2007 to 2010, 24041 women between the ages of
18 and 60 years who were permanent residents in the
northeast of China were eligible to participate. All
women were composed of healthy Chinese women who
had underwent cervical cancer screening in our Health
Check Center or at the Department of Obstetrics and
Gynecology, Shengjing Afiliated Hospital of China
Medical University. These women were not pregnant during
their first visit and also had no intention to be pregnant
during the first year of follow-up. Moreover, we excluded
patients who had a history of hysterectomy, o (...truncated)