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JCO：子宫颈上皮内瘤变Ⅲ级者，其它部位的HPV相关肿瘤风险长期持续增加

2017-05-31 MedSci MedSci原创

子宫颈上皮内瘤变HPV宫颈癌
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子宫颈上皮内瘤变（cervical intraepithelial neoplasia CIN）：将子宫颈上皮非典型增生至原位癌这一系列癌前病变的连续过程称为子宫颈上皮内瘤变。根据细胞改变程度和异型细胞范围可将CIN分为三级：Ⅰ级为轻度不典型增生，不典型细胞局限于上皮下1/3；Ⅱ级为中度不典型增生，不典型细胞主要位于上皮下1/3～2/3层，细胞极性尚存；Ⅲ级为重度不典型增生和（或）原位癌，病变细胞

子宫颈上皮内瘤变（cervical intraepithelial neoplasia CIN）：将子宫颈上皮非典型增生至原位癌这一系列癌前病变的连续过程称为子宫颈上皮内瘤变。根据细胞改变程度和异型细胞范围可将CIN分为三级：Ⅰ级为轻度不典型增生，不典型细胞局限于上皮下1/3；Ⅱ级为中度不典型增生，不典型细胞主要位于上皮下1/3～2/3层，细胞极性尚存；Ⅲ级为重度不典型增生和（或）原位癌，病变细胞几乎或全部占据上皮全层，伴有核分裂相增多，极性消失。大体上CIN有15%可发展为宫颈癌，其中CINⅠ、Ⅱ、Ⅲ级发展到癌的危险性分别为15%、30%和45%。

最近的一期JCO上刊登了一篇研究，该研究探讨了被确诊为宫颈上皮内瘤变Ⅲ级（CIN3）的女性患人类乳头状瘤病毒（HPV）相关癌变和癌前病变的风险。这种风险的认知对阻止疾病进展和预防其它HPV相关的癌变和癌前病变的发生发展至关重要，通过在确诊为CIN3时，考虑接种HPV预防疫苗和/或高度关注其他HPV相关的肿瘤和癌前病变。

研究人员对荷兰全国组织学和细胞学病理登记中心（PALGA）选取了1990-2010年间被诊断为CIN3的女性，并与没有CIN3的女性相匹配设置对照组。随后，提取1990-2015年间在肛门生殖器区和口咽部的有高风险HPV相关性肿瘤和高级别病变的所有患者，对外阴、阴道、肛门和口咽部的癌变和癌前病变的发生率的比值进行估算。

共有178036名女性参与该研究；89018名既往诊断为CIN3，和89018无CIN3既往史的匹配对照组。有CIN3既往史的妇女的HPV相关的癌变和癌前病变风险增加，肛门癌的发生率比值为3.85（95% CI，2.32-6.37）肛门上皮内瘤变3级的RR为6.68（95% CI，3.64-12.25），外阴癌的RR为4.97（95% CI，3.26-7.57），外阴上皮内瘤变3级的RR为13.66（93% CI，9.69-19.25），阴道癌的RR为86.08（95% CI，11.98-618.08），阴道上皮内瘤变3级的RR为25.65（95% CI，10.50-62.69），以及口咽癌的RR为5.51（95% CI，1.22－24.84）。即使经过长达20年的长期随访，这种风险仍持续显著增加。

这项以人群为基础的研究表明：被诊断出CIN3后，患者肛门与生殖器区域、口咽部HPV相关的癌变和癌前病变的风险会长期持续增加。为预防这种风险的增加，在这类患者中进行某些措施如强化筛查或接种疫苗是必要的。

原始出处：

Ebisch RMF, Rutten DWE，et al.Long-Lasting Increased Risk of Human Papillomavirus-Related Carcinomas and Premalignancies After Cervical Intraepithelial Neoplasia Grade 3: A Population-Based Cohort Study.J Clin Oncol. 2017 May 25:JCO2016714543. doi: 10.1200/JCO.2016.71.4543. [Epub ahead of print]

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    2017-12-05 mjldent

    #肿瘤风险#

    0

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    2017-07-29 lidong40

    #JCO#

    0

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    2017-07-20 ms7474195563676018

    #子宫颈#

    0

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    2017-06-05 日月生辉

    在这里，每天学习真有益处!会天天来

    0

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    2017-06-03 ylzr123

    感谢小编为我们精心准备了如此精辟的精神大餐，小编辛苦了，点个赞吧！

    0

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    2017-06-02 一闲

    #宫颈#

    0

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    2017-05-31 solarjin

    感谢梅斯医学，受教了

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=2026018, encodeId=fc1b20260185c, content=<a href='/topic/show?id=c3048314322' target=_blank style='color:#2F92EE;'>#肿瘤风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83143, encryptionId=c3048314322, topicName=肿瘤风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5662228, createdName=mjldent, createdTime=Tue Dec 05 09:09:00 CST 2017, time=2017-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1891366, encodeId=3ad61891366e0, content=<a href='/topic/show?id=25b0102e2df' target=_blank style='color:#2F92EE;'>#JCO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10272, encryptionId=25b0102e2df, topicName=JCO)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6da1120, createdName=lidong40, createdTime=Sat Jul 29 14:09:00 CST 2017, time=2017-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2006686, encodeId=a36f200668627, content=<a href='/topic/show?id=199d452095f' target=_blank style='color:#2F92EE;'>#子宫颈#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45209, encryptionId=199d452095f, topicName=子宫颈)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKjqGDO7icVKUiaT7urgwXvnvzWtp0fMFU46Xfib8oavFKygiaWtibXReS6ZUh3PImsNicGAwTO5HXxoicnA/132, createdBy=ee262500130, createdName=ms7474195563676018, createdTime=Thu Jul 20 22:09:00 CST 2017, time=2017-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=206685, encodeId=f85b2066852b, content=在这里，每天学习真有益处!会天天来, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib260FNcic8ThYQJjaU2fLIb1yNqibkbdJs7gVIDr9xJyYeiapArSMjn3W61bPJtpIazSdAxRaFEOKYgfQjX4achN2d/0, createdBy=68472058812, createdName=日月生辉, createdTime=Mon Jun 05 07:07:15 CST 2017, time=2017-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205936, encodeId=c473205936f0, content=感谢小编为我们精心准备了如此精辟的精神大餐，小编辛苦了，点个赞吧！, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sat Jun 03 09:27:33 CST 2017, time=2017-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1408033, encodeId=54cc140803335, content=<a href='/topic/show?id=92194628826' target=_blank style='color:#2F92EE;'>#宫颈#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46288, encryptionId=92194628826, topicName=宫颈)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=11102737131, createdName=一闲, createdTime=Fri Jun 02 11:09:00 CST 2017, time=2017-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=204909, encodeId=313b20490921, content=感谢梅斯医学，受教了, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/icyLhIGqru6gIknBJqfuPhbPwBo0yCebU4qpdSwzpBA1WFXMEUicoTnJDickpj9Ve1cUdNjjTiaDXmpXL47LYh3DdYkPOA2kddyZ/0, createdBy=508c2054450, createdName=solarjin, createdTime=Wed May 31 20:39:22 CST 2017, time=2017-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=204902, encodeId=98c520490260, content=涨知识，值得分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Wed May 31 20:36:26 CST 2017, time=2017-05-31, status=1, ipAttribution=)]
    2017-05-31 1ddf0692m34(暂无匿称)

    涨知识，值得分享

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