Purpose: To investigate the prevalence of precancers [high-grade squamous intraepithelial lesion (HSIL) and adenocarcinoma in situ (AIS)] and cancers [squamous cell carcinoma (SCC) and adenocarcinoma (ADC)] in various high-risk human papillomavirus (hrHPV) genotypes or age groups among women with negative for intraepithelial lesion or malignancy (NILM) and hrHPV-positive pap results.
Materials and Methods: In total, 26,228 women with NILM/hrHPV+ were included in the study. Among them, 5893 had immediate follow-up biopsy results available and were selected for further prevalence analysis.
Results: About 7.6% and 0.7% women with NILM/hrHPV+ had HSIL and AIS, respectively. The prevalence of HSIL+ squamous lesions is significantly higher in HPV-16+ group than that in other genotype groups (p < 0.0001). The prevalence of AIS+ glandular lesions is significantly higher in HPV-18/45+ groups than women in other genotype groups (p < 0.0001). In addition, the prevalence of HSIL+ lesions was significantly higher in age 25– 39 years group than that in age 40– 65 years group and > 65 years group (p < 0.0001). Overall, the prevalence of HSIL+ in younger women was significantly higher than that in older women when using a cutoff age of 40 years (9.3% vs 5.9%, p < 0.0001) or 50 years (8.6% vs 4.9%, p < 0.0001). No significant difference in AIS+ prevalence was found among different age groups (p = 0.611). Interestingly, the prevalence of SCC and ADC in older women (≥ 40 years, 0.3% and 0.3%, respectively) was significantly higher than that in younger women (< 40 years, 0% and 0.07%) (p = 0.001 for SCC; p = 0.02 for ADC).
Conclusion: The significant risk of cervical precancers and cancers still exists in women with NILM/hrHPV+, notably the older patient group had a lower risk of cervical precancer, but higher risk of cancer. Therefore, HPV genotyping can be an effective supplemental tool to cytology, and patient age also needs to be considered in the clinical management of patient.

Keywords: risk stratification, E6/E7 mRNA genotyping, NILM, hrHPV


中文翻译：

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HPV 基因型特异性和年龄分层的 NILM/hrHPV+ 女性宫颈癌前病变和癌症的即时患病率：26,228 例的单中心回顾性研究

目的：调查各种高危人乳头瘤病毒 (hrHPV) 中癌前病变 [高级别鳞状上皮内病变 (HSIL) 和原位腺癌 (AIS)] 和癌症 [鳞状细胞癌 (SCC) 和腺癌 (ADC)] 的患病率) 上皮内病变或恶性肿瘤 (NILM) 阴性和 hrHPV 阳性 pap 结果的女性的基因型或年龄组。
材料和方法：本研究共纳入 26,228 名 NILM/hrHPV+ 女性。其中，5893 人获得了即时随访活检结果，并被选中进行进一步的患病率分析。
结果：大约 7.6% 和 0.7% 的 NILM/hrHPV+ 女性分别患有 HSIL 和 AIS。HPV-16+组HSIL+鳞状病变的患病率显着高于其他基因型组（p <0.0001）。HPV-18/45+ 组的 AIS+ 腺体病变患病率显着高于其他基因型组的女性（p < 0.0001）。此外，25~39岁组HSIL+病变的患病率显着高于40~65岁组和>65岁组（p <0.0001）。总体而言，当使用 40 岁（9.3% vs 5.9%，p < 0.0001）或 50 岁（8.6% vs 4.9%，p< 0.0001)。不同年龄组的 AIS+ 患病率无显着差异 ( p = 0.611)。有趣的是，老年女性（≥ 40 岁，分别为 0.3% 和 0.3%）的 SCC 和 ADC 患病率显着高于年轻女性（<40 岁，分别为 0% 和 0.07%）（ SCC 的p = 0.001；对于 ADC， p = 0.02）。
结论：宫颈癌前病变和癌症的显着风险仍然存在于 NILM/hrHPV+ 女性中，尤其是老年患者组宫颈癌前病变的风险较低，但患癌的风险较高。因此，HPV基因分型可以作为细胞学的有效补充工具，在患者的临床管理中也需要考虑患者年龄。

关键词：风险分层、E6/E7 mRNA 基因分型、NILM、hrHPV