title: Predicting the progression of cervical precursor lesions by human papillomavirus genotyping: a prospective cohort study.
abstract: Only a subset of cervical precursor lesions progress to cervical cancer and because of the lack of the predictive markers, it cannot be ascertained which lesions will progress or not. To estimate the risk of disease progression associated with human papillomavirus (HPV) genotypes, we followed 570 Japanese women with cytological LSIL (low-grade squamous intraepithelial lesion) and histological CIN (cervical intraepithelial neoplasia) grade 1-2 lesions (479 CIN 1; 91 CIN 2) at 3 to 4 month intervals for a mean follow-up period of 39.1 months. At entry, we detected HPV DNA in cervical samples by polymerase chain reaction-based methodology. Over the period of follow-up period, 46 lesions progressed to CIN 3 while 362 regressed to normal cytology. Women with multiple HPV infections were more likely to have persistent lesions (hazard ratio [HR] for regression, 0.65; 95% confidence interval [CI], 0.42-1.02; p = 0.07); however, multiple infections did not increase the risk of progression (HR for progression, 1.04; 95% CI, 0.37-2.94; p = 0.94). After adjusting for CIN grade and women's age, HRs for progression to CIN 3 (vs. women with low-risk types or negative for HPV DNA) varied markedly by HPV genotype: type 16 (11.1, 95% CI: 1.39-88.3); 18 (14.1, 0.65-306); 31 (24.7, 2.51-243); 33 (20.3, 1.78-231); 35 (13.7, 0.75-251); 52 (11.6, 1.45-93.3); 58 (8.85, 1.01-77.6); other high-risk types (4.04, 0.47-34.7). HPV 45 was not detected in our study subjects. The cumulative probability of CIN 3 within 5 years was 20.5% for HPV 16, 18, 31, 33, 35, 52 and 58; 6.0% for other high-risk types; 1.7% for low-risk types (p = 0.0001). In conclusion, type-specific HPV testing for women with LSIL/CIN 1-2 lesions is useful for identifying populations at increased or decreased risk of disease progression.
authors: Department of Obstetrics and Gynecology, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan. matsumok@mui.biglobe.ne.jp
authors: Koji
authors: K
authors: Matsumoto
authors: Akinori
authors: A
authors: Oki
authors: Reiko
authors: R
authors: Furuta
authors: Hiroo
authors: H
authors: Maeda
authors: Toshiharu
authors: T
authors: Yasugi
authors: Naoyoshi
authors: N
authors: Takatsuka
authors: Akira
authors: A
authors: Mitsuhashi
authors: Takuma
authors: T
authors: Fujii
authors: Yasuo
authors: Y
authors: Hirai
authors: Tsuyoshi
authors: T
authors: Iwasaka
authors: Nobuo
authors: N
authors: Yaegashi
authors: Yoh
authors: Y
authors: Watanabe
authors: Yutaka
authors: Y
authors: Nagai
authors: Tomoyuki
authors: T
authors: Kitagawa
authors: Hiroyuki
authors: H
authors: Yoshikawa
mesh_terms: D052685:Alphapapillomavirus / Q000235:genetics*; D001483:Base Sequence; D017931:DNA Primers; D004279:DNA, Viral / Q000235:genetics; D018450:Disease Progression; D005260:Female; D005838:Genotype; D006801:Humans; D011446:Prospective Studies; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000821:virology
chemical_list: D017931:DNA Primers; D004279:DNA, Viral