《臨床腫瘤學(xué)雜志》(Journal of Clinical Oncology) 7月30日在線發(fā)表的一份研究報告顯示,，只需進行1次HPV DNA檢測即可預(yù)測至少未來18年內(nèi)女性患宮頸癌的風(fēng)險,，識別出哪些人已經(jīng)患有浸潤性宮頸癌,，哪些人的HPV感染未來會導(dǎo)致發(fā)病。相比之下,，巴氏涂片檢查無法預(yù)測1~2年后具有重要臨床意義的疾病,。
美國臨床腫瘤學(xué)會(ASCO)的Philip E. Castle博士及其同事對來自俄勒岡州波特蘭市的由19，512名女性組成的隊列進行了分析,，所有受試者均在1989~1990年接受了常規(guī)細(xì)胞學(xué)篩查,，基線年齡介于16~94歲,。研究者采用目前臨床上常規(guī)使用的商業(yè)化診斷性檢查手段對受試者的宮頸陰道灌洗液進行了回顧性HPV DNA檢測。
受試者接受了大約18年的隨訪,，每年進行1次巴氏涂片檢查,。在此期間共有199例被確診為患有浸潤性宮頸癌(宮頸上皮內(nèi)瘤樣病變[CIN]3級+)，共發(fā)現(xiàn)396例CIN2+患者,?；€巴氏涂片陽性對于2年內(nèi)的宮頸癌具有很強的預(yù)測價值，但無法預(yù)測該時間點之后的宮頸癌風(fēng)險,。相比之下,，HPV DNA檢測陽性可持續(xù)預(yù)測受試者的宮頸癌風(fēng)險直至研究結(jié)束。
舉例來說,，在入組研究后10~18年期間,，與HPV陰性者相比，HPV陽性者被診斷為CIN2+ 和 CIN3+的幾率更大,，而巴氏涂片陽性者被診斷為CIN2+ 或CIN3+的幾率并未高于巴氏涂片陰性者,。
同樣，基線單次HPV檢測陰性與單次巴氏涂片陰性相比,，“更能保證受試者在未來18年的隨訪期內(nèi)出現(xiàn)CIN2+(1.85% vs. 2.47%)和CIN3+(0.90% vs. 1.27%)的可能性不大,。”此外，與巴氏涂片陽性結(jié)果相比,，HPV陽性結(jié)果后出現(xiàn)CIN2+(215例 vs. 136例)和CIN3+(112例vs. 65例)的病例數(shù)也更多,。在基線HPV DNA檢測陽性且隨后出現(xiàn)了CIN2+或CIN3+的受試者中，只有一半患者的巴氏涂片檢查結(jié)果呈陽性,。
研究者稱,，上述結(jié)果“進一步支持HPV檢測作為30歲及30歲以上女性的常規(guī)篩查方法。”此外,，其他研究結(jié)果表明HPV檢測還可能有助于識別出哪些女性存在罹患宮頸原位腺癌和浸潤性腺癌的風(fēng)險,，而這兩種疾病“單純通過細(xì)胞學(xué)篩查是很難發(fā)現(xiàn)的”。
Castle博士及其同事指出：“與巴氏涂片檢查相比,，HPV檢測對于CIN3和宮頸癌的預(yù)測價值更大,，因此可以作為健康女性的宮頸癌篩查手段。而巴氏涂片則可以作為次要的診斷性檢查來識別出哪些HPV陽性者近期就有患上浸潤性宮頸癌的風(fēng)險,。”
該研究的部分經(jīng)費由美國國立癌癥研究所資助,。Castle博士聲明與默克、Qiagen和羅氏公司存在利益關(guān)系,，其同事Attila T. Lorincz博士聲明與Qiagen公司存在利益關(guān)系。（生物谷Bioon.com）
doi：10.1200/JCO.2011.38.8389
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Clinical Human Papillomavirus Detection Forecasts Cervical Cancer Risk in Women Over 18 Years of Follow-Up
Philip E. Castle,， Andrew G. Glass,， Brenda B. Rush,， David R. Scott， Nicolas Wentzensen,， Julia C. Gage,， Julie Buckland， Greg Rydzak,， Attila T. Lorincz and Sholom Wacholder
Purpose To describe the long-term (≥ 10 years) benefits of clinical human papillomavirus (HPV) DNA testing for cervical precancer and cancer risk prediction.
Methods Cervicovaginal lavages collected from 19,，512 women attending a health maintenance program were retrospectively tested for HPV using a clinical test. HPV positives were tested for HPV16 and HPV18 individually using a research test. A Papanicolaou (Pap) result classified as atypical squamous cells of undetermined significance (ASC-US) or more severe was considered abnormal. Women underwent follow-up prospectively with routine annual Pap testing up to 18 years. Cumulative incidence rates (CIRs) of ≥ grade 3 cervical intraepithelial neoplasia (CIN3+) or cancer for enrollment test results were calculated.
Results A baseline negative HPV test provided greater reassurance against CIN3+ over the 18-year follow-up than a normal Pap (CIR， 0.90% v 1.27%). Although both baseline Pap and HPV tests predicted who would develop CIN3+ within the first 2 years of follow-up,， only HPV testing predicted who would develop CIN3+ 10 to 18 years later (P = .004). HPV16- and HPV18-positive women with normal Pap were at elevated risk of CIN3+ compared with other HPV-positive women with normal Pap and were at similar risk of CIN3+ compared with women with a low-grade squamous intraepithelial Pap.
Conclusion HPV testing to rule out cervical disease followed by Pap testing and possibly combined with the detection of HPV16 and HPV18 among HPV positives to identify those at immediate risk of CIN3+ would be an efficient algorithm for cervical cancer screening,， especially in women age 30 years or older.
