Co-factors of high-risk human papillomavirus infections display unique profiles in incident CIN1, CIN2 and CIN3

被引:9
作者
Syrjanen, K. [1 ]
Shabalova, I. [2 ]
Naud, P. [3 ,4 ]
Derchain, S. [5 ]
Sarian, L. [5 ]
Kozachenko, V. [2 ]
Zakharchenko, S. [6 ]
Roteli-Martins, C. [7 ]
Nerovjna, R. [8 ]
Longatto-Filho, A. [9 ,10 ]
Kljukina, L. [11 ]
Tatti, S. [12 ]
Branovskaja, M. [13 ]
Branca, M. [14 ]
Grunjberga, V. [15 ,16 ]
Erzen, M. [17 ]
Juschenko, A. [15 ,16 ]
Hammes, L. Serpa [2 ]
Costa, S. [18 ]
Podistov, J. [19 ]
Syrjanen, S. [20 ]
机构
[1] Turku Univ Hosp, Dept Radiotherapy & Oncol, Turku 20521, Finland
[2] Russian Acad Postgrad Med Educ, Moscow, Russia
[3] Univ Fed Rio Grande do Sul, Hosp Clin Porto Alegre, Porto Alegre, RS, Brazil
[4] Univ Fed Rio Grande do Sul, Dept Gynecol & Obstet, Porto Alegre, RS, Brazil
[5] Univ Estadual Campinas, Campinas, Brazil
[6] Novgorod Municipal Dermatovenereol Dispensary, Dept Gynaecol, Novgorod, Russia
[7] Hosp Leonor M de Barros, Sao Paulo, Brazil
[8] Novgorod Female Consultat Outpatient Hosp, Dept Gynaecol, Novgorod, Russia
[9] Univ Minho, Sch Hlth Sci, Life & Hlth Sci Res Inst ICVS, Braga, Portugal
[10] Adolfo Lutz Inst, Sao Paulo, Brazil
[11] Republ Ctr Clin Cytol, Oncol & Med Radiol Res Inst, Minsk, BELARUS
[12] First Chair Gynecol Hosp Clin, Buenos Aires, DF, Argentina
[13] Minsk State Med Inst, Dept Obstet & Gynaecol, Minsk, BELARUS
[14] Natl Inst Hlth ISS, Natl Ctr Epidemiol Surveillance & Promot Hlth, Unit Cytopathol, Rome, Italy
[15] Latvian Canc Ctr, Dept Gynaecol, Riga, Latvia
[16] Latvian Canc Ctr, Lab Cytol, Riga, Latvia
[17] SIZE Diagnost Ctr, Ljubljana, Slovenia
[18] St Orsola Marcello Malpighi Hosp, Dept Obstet & Gynecol, Bologna, Italy
[19] Russian Acad Med Sci, NN Blokhin Canc Res Ctr, Moscow, Russia
[20] Univ Turku, Dept Oral Pathol, Inst Dent, Turku, Finland
关键词
CIN; HPV; co-factors; progression; multinomial regression; prospective follow-up; NIS Cohort; LAMS Study; CERVICAL INTRAEPITHELIAL NEOPLASIA; LOW-RESOURCE SETTINGS; HPV INFECTIONS; LATIN-AMERICA; SCREENING TOOLS; INDEPENDENT STATES; VISUAL INSPECTION; NATURAL-HISTORY; YOUNG-WOMEN; END-POINTS;
D O I
10.1258/ijsa.2009.009280
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
In addition to oncogenic 'high-risk' human papillomaviruses (HR-HPV), several co-factors are needed in cervical carcinogenesis, but it is poorly understood whether these HPV co-factors associated with incident cervical intraepithelial neoplasia (CIN) grade 1 are different from those required for progression to CIN2 and CIN3. To gain further insights into the true biological differences between CIN1, CIN2 and CIN3, we assessed HPV co-factors increasing the risk of incident CIN1, CIN2 and CIN3. Data from the New Independent States of the Former Soviet Union (NIS) Cohort (n = 3187) and the Latin American Screening (LAMS) Study (n = 12,114) were combined, and co-factors associated with progression to CIN1, CIN2 and CIN3 were analysed using multinomial logistic regression models with all covariates recorded at baseline. HR-HPV-positive women (n = 1105) represented a subcohort of all 1865 women prospectively followed up in both studies. Altogether, 90(4.8%), 39 (2.1%) and 14 (1.4%) cases progressed to CIN1, CIN2 and CIN3, respectively. Baseline HR-HPV was the single most powerful predictor of incident CIN1, CIN2 and CIN3. When controlled for residual HPV confounding by analysing HR-HPV-positive women only, the risk profiles of incident CIN1, CIN2 and CIN3 were unique. Completely different HPV co-factors were associated with progression to CIN1, CIN2 and CIN3 in univariate and multivariate analyses, irrespective of whether non-progression, CIN1 or CIN2 was used as the reference outcome. HPV co-factors associated with progression to CIN1, CIN2 and CIN3 display unique profiles, implicating genuine biological differences between the three CIN grades, which prompts us to re-visit the concept of combining CIN2 with CIN3 or CIN1.
引用
收藏
页码:263 / 272
页数:10
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