Ranking the attribution of high-risk genotypes among women with cervical precancers and cancers: a cross-sectional study in Ningbo, China

IF 3.1 2区医学 Q3 IMMUNOLOGY Infectious Agents and Cancer Pub Date : 2024-09-12 DOI:10.1186/s13027-024-00598-z

Shimin Chen, Shangying Hu, Jian Yin, Wenying Yu, Xun Zhang, Xi Deng, Huaxin Ding, Jinyu Zhang, Yan Song, Qiming Wang, Liang Chen, Feng Guo, Susanne Hartwig, Fanghui Zhao

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Abstract

The region-specific importance of carcinogenic HPV genotypes is required for optimizing HPV-based screening and promoting appropriate multivalent HPV prophylactic vaccines. This information is lacking for Ningbo, one of the first cities of China’s Healthy City Innovation Pilot Program for Cervical Cancer Elimination. Here, we investigated high-risk HPV (HR-HPV) genotype-specific distribution and attribution to biopsy-confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+) before mass vaccination in Ningbo, China. A total of 1393 eligible CIN2+ archived blocks (including 161 CIN2, 1107 CIN3, and 125 invasive cervical cancers [ICC]) were collected from 2017 to 2020 in Ningbo. HR-HPV DNA was genotyped using the SPF10-DEIA-LiPA25 version 1 detection system and the SureX HPV 25X Genotyping Kit. Genotype-specific attribution to CIN2+ was estimated using a fractional contribution approach. Ranking by the attributable proportions, HPV16 remained the most important genotype in both cervical precancers and cancers, accounting for 36.8% of CIN2, 53.2% of CIN3, and 73.3% of ICC cases. Among cervical precancers, HPV52 (17.3% in CIN2, 12.7% in CIN3) and HPV58 (13.9%, 14.9%) ranked second and third, while HPV33 (8.3%, 7.9%) and HPV31 (6.5%, 4.1%) ranked fourth and fifth, respectively. However, among ICCs, HPV18 (5.7%) accounted for the second highest proportion, followed by HPV33 (5.4%), HPV58 (4.0%), and HPV45 (3.2%). HPV18/45 together accounted for 46.8% of adenocarcinomas, which was slightly lower than that of HPV16 (47.7%). The remaining HR-HPV genotypes (HPV35/39/51/56/59/66/68) combined accounted for only 6.7% of CIN2, 2.9% of CIN3, and 4.2% of ICC. With Ningbo’s strong medical resources, it will be important to continue HPV16/18 control efforts, and could broaden to HPV31/33/45/52/58 for maximum health benefits. However, different strategies should be proposed for other HR-HPV genotypes based on their lower carcinogenic risks.

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宫颈癌前病变和宫颈癌妇女的高危基因型排序：中国宁波的一项横断面研究

要优化基于人乳头瘤病毒的筛查并推广适当的多价人乳头瘤病毒预防性疫苗，就必须了解特定地区致癌人乳头瘤病毒基因型的重要性。宁波是中国首批 "消除宫颈癌健康城市创新试点计划 "的城市之一，但目前还缺乏这方面的信息。在此，我们调查了高危型人乳头瘤病毒（HR-HPV）基因型的特异性分布以及在中国宁波大规模接种疫苗前经活检证实的宫颈上皮内瘤变 2 级或更严重（CIN2+）的归因。从2017年至2020年，宁波共收集了1393个符合条件的CIN2+存档区块（包括161个CIN2、1107个CIN3和125个浸润性宫颈癌[ICC]）。使用SPF10-DEIA-LiPA25版本1检测系统和SureX HPV 25X基因分型试剂盒对HR-HPV DNA进行基因分型。采用分数贡献法估算了基因型对 CIN2+ 的特异性归因。按归因比例排序，HPV16 仍是宫颈癌前病变和癌症中最重要的基因型，占 CIN2 的 36.8%、CIN3 的 53.2%、ICC 病例的 73.3%。在宫颈癌前病变中，HPV52（在 CIN2 中占 17.3%，在 CIN3 中占 12.7%）和 HPV58（分别占 13.9%和 14.9%）分列第二和第三位，而 HPV33（分别占 8.3%和 7.9%）和 HPV31（分别占 6.5%和 4.1%）分列第四和第五位。然而，在 ICCs 中，HPV18（5.7%）占第二高比例，其次是 HPV33（5.4%）、HPV58（4.0%）和 HPV45（3.2%）。HPV18/45合计占腺癌的46.8%，略低于HPV16（47.7%）。其余HR-HPV基因型（HPV35/39/51/56/59/66/68）加起来仅占CIN2的6.7%、CIN3的2.9%和ICC的4.2%。宁波拥有雄厚的医疗资源，因此继续开展 HPV16/18 的控制工作非常重要，并可扩大到 HPV31/33/45/52/58，以获得最大的健康效益。不过，对于其他HR-HPV基因型，应根据其较低的致癌风险提出不同的策略。

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来源期刊

Infectious Agents and Cancer ONCOLOGY-IMMUNOLOGY

CiteScore

5.80

自引率

2.70%

发文量

期刊介绍： Infectious Agents and Cancer is an open access, peer-reviewed online journal that encompasses all aspects of basic, clinical, epidemiological and translational research providing an insight into the association between chronic infections and cancer. The journal welcomes submissions in the pathogen-related cancer areas and other related topics, in particular: • HPV and anogenital cancers, as well as head and neck cancers; • EBV and Burkitt lymphoma; • HCV/HBV and hepatocellular carcinoma as well as lymphoproliferative diseases; • HHV8 and Kaposi sarcoma; • HTLV and leukemia; • Cancers in Low- and Middle-income countries. The link between infection and cancer has become well established over the past 50 years, and infection-associated cancer contribute up to 16% of cancers in developed countries and 33% in less developed countries. Preventive vaccines have been developed for only two cancer-causing viruses, highlighting both the opportunity to prevent infection-associated cancers by vaccination and the gaps that remain before vaccines can be developed for other cancer-causing agents. These gaps are due to incomplete understanding of the basic biology, natural history, epidemiology of many of the pathogens that cause cancer, the mechanisms they exploit to cause cancer, and how to interrupt progression to cancer in human populations. Early diagnosis or identification of lesions at high risk of progression represent the current most critical research area of the field supported by recent advances in genomics and proteomics technologies.